Podiatry Coding & Billing Alert
Check Incision Before Reporting Foot FBR
Question: Our podiatrist recently saw a patient who came limping with pain in the clinic. After giving an examination, the podiatrist found a splinter in the back of her heel of her foot. The physician examined the injured area, and pulled the splinter out using tweezers. How should we report this encounter? Can we code this as 28190?
Oregon Subscriber
Answer: No, although what you are describing is a foot foreign body removal (FBR) and according to the code descriptors for foot FBRs, you will not be able to report 28190 (Removal of foreign body, foot; subcutaneous) for the encounter. According to our experts even though the CPT® descriptor excludes “incision,” you should not report 28190 unless the provider makes an incision.
While the descriptors might appear to justify the assignment of 28190-28193 if no incision is made, CPT® guidelines consider that a non-invasive procedure and will not warrant any additional coding besides the E/M.
To be maximally compliant, treat foot FBRs like you treat soft-tissue FBRs. If the provider does not make an incision, your best bet may be to report an E/M code for the service (99201-99205, Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: …)
Any of the FBR codes in the musculoskeletal chapter [of CPT®] involve an incision going beyond the skin level. You need an incision to get that deep before reporting 28190-28193.
Best bet: At the very least, check your payer contract before coding a foot FBR sans incision.
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