Podiatry Coding & Billing Alert

Question: The podiatrist performed a level-three evaluation and management (E/M) service for an established patient. In the medical documentation, the podiatrist noted that the patient suffered from a solitary bone cyst in her right ankle and foot. Which ICD-10 and CPT^® codes should I report? And what is the difference between a solitary bone cyst and an aneurysmal bone cyst?

Ohio Subscriber

Answer: You should report M85.471 (Solitary bone cyst, right ankle and foot) in this situation. For the E/M code, you would report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity …).

Now, a bit more information about both types of bone cysts.

Solitary bone cyst defined: A solitary bone cyst of the right ankle and foot is a benign, empty or fluid-filled, cavity in the bones that weakens the bones; also known as a simple bone cyst. You should report solitary bone cysts with a code from the M85.4- (Solitary bone cyst) set.

Aneurysmal bone cyst: An aneurysmal bone cyst is a benign lesion that occurs in the bones, consists of blood-filled channels, and resembles a tumor. You should report aneurysmal bone cysts with a code from the M85.5- (Aneurysmal bone cyst) set.

Other/unspecified bone cyst: If you can’t get a ruling on which type of bone cyst your podiatrist is dealing with, then you should look to the M85.6- (Other cyst of bone) code set.