You need to distinguish between subcutaneous vs. subfascial cuts.
If you’re not recouping what you’re owed for foot tumor excisions, you could be mistaking simple lesions for tumors or omitting debridement, lesion shaving, or excision codes. We’ll put you on the path to successful payouts by removing any confusion about the differences between tumors and lesions and their codes.
Codes Change As You Go Deeper in the Skin
Before going into the actual coding scenarios, you should know two key terms that you will often encounter in your podiatrist’s op notes. Understanding the difference between these terms is pivotal to further coding success, as the excision codes have been stacked according to the difficulty faced by the physician in removing the lesion or tumor:
There are three common lesion treatment options: debridement, shaving, and excision. Keep a sharp eye out on the podiatrist’s notes to see how deep the podiatrist went to remove the lesion from the foot.
Debridement: This procedure involves the surgical removal of dead or damaged tissue or skin. Shaving is the removal of dead skin using a slicing or sawing motion. The CPT® manual provides the following debridement codes for lesions:
Excision: Excision is the surgical removal of an organ or tissue (lesion or tumor) through an incision as deep as or deeper than the full thickness of the skin. You require sutures to allow the surgical wound to heal for an excision.
Excision vs. radical resection: Other than excision, another procedure podiatrists use to remove tumors is radical resection (excision of all or part of an organ or tissue, along with the blood supply and lymph system supplying the organ or tissue). However, the distinguishing feature of resection is that it is used mostly to remove malignant tumors. You can spot radical resection in your procedure notes by looking at the large area covered by the procedure.
“Another distinguishing feature of excision versus radical resection is whether the podiatrist carried the procedure subcutaneously or subfascially. When the podiatrist removes tissues below fascia, then he is getting into radical resections,” informs Arnold Beresh, DPM, CPC, of Peninsula Foot and Ankle Specialists PLC in Hampton, Va.
Don’t Ignore the Size of Lesion
Check your podiatrist’s operative report, specially the size, depth, and location of each growth for correct choice of lesion excision code. The report will also provide a correct representation of the amount of work your podiatrist had to do, and hence his compensation. You can report from among the following CPT® podiatry codes for shaving or excision, depending on the size/diameter of the lesion removed:
It is crucial to correctly document the total lesion size as it determines the proper code to use and the total size includes the surrounding margins that were removed.
Caution: Simple and intermediate repairs are now included in the codes for the excision, so don’t code a separate closure unless the physician documents that he or she performed a complex closure, adds Dr. Beresh.
Draw a Line Between Lesions and Tumors
You can decipher that the procedure is a tumor removal by checking the podiatrist’s documentation for terms such as “musculoskeletal in origin” or “soft tissue.” For reporting tumor removal codes, you will choose from among the CPT® 28000 series. However, before pinpointing the code, ensure to check the size of the excised tumor:
You can choose from among codes 28039 (Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater); 28041 (Excision, tumor, soft tissue of foot or toe, subfascial[e.g., intramuscular]; 1.5 cm or greater); 28043 (Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm); 28045 (Excision, tumor, soft tissue of foot or toe, subfascial[e.g., intramuscular]; less than 1.5 cm); 28046 (Radical resection of tumor [e.g., sarcoma], soft tissue of foot or toe; less than 3 cm)and28047 (Radical resection of tumor [e.g., sarcoma], soft tissue of foot or toe; 3 cm or greater).
Documentation Leads the Way in Soft Tissue Excisions
Ensure that the physician has included the following information in the documentation when they excise a skin or soft tissue lesion: