Podiatry Coding & Billing Alert

Question: I am coding for a patient who is diabetic w/ osteomyelitis w/ chronic ulcer 5th ray. How should I sequence the diagnosis codes? What should I code for the resection of both the eroded metatarsal bone and base of the proximal phalanx? I am considering 28005 vs. 28122?

Nevada Subscriber

Answer: You should code the diagnosis as the following

1. 250.60 (Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled)

2. 730.28 (Unspecified osteomyelitis involving other specified sites),

3. 707.15 (Ulcer of other part of foot).

Code 28005 (Incision, bone cortex [e.g., osteomyelitis or bone abscess], foot) is not correct here as the code is non-specific and addresses only the incision and not the resection. CPT® code 28122 (Partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; tarsal or metatarsal bone, except talus or calcaneus) is a better choice for the given scenario. To capture the resection of proximal phalanx, you can additionally report 28124 (Partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; phalanx of toe).