Podiatry Coding & Billing Alert

Question: Recently, a patient came in complaining about mild pain after stepping on a pile of branches and sustaining a puncture wound. The patient was unable to locate a foreign object. The podiatrist examined the patient's right foot, plantar aspect and suspected a deep foreign body of the middle and medial aspect of the foot. The patient did not have an ankle injury, and his foot and ankle exam were otherwise negative. The podiatrist used local anesthesia 1% lidocaine with epinephrine and prepped the wound with Betadine®. He then made an incision with a #11 blade. The podiatrist irrigated the wound and explored it extensively with the margins extended. The foreign body was visualized, and the podiatrist saw that it appeared to be imbedded in the deep tissues of the foot with a portion into the fascia. The podiatrist removed the foreign body and controlled the bleeding without additional complications. He applied dressing to the wound. What CPT^® code would we report?

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Answer: In this situation, you would report the podiatrist's service with 28192 (Removal of foreign body, foot; deep). The procedure did include the incision, so it meets the requirements for 10120 (Incision and removal of foreign body, subcutaneous tissues; simple). However, since the foreign body penetrated deep into the patient's fascia, the more accurate code choice would be 28192.

The CPT^® description for 10120 means the podiatrist must make an incision to remove the foreign body as opposed to removing it with forceps. Code 10120 is listed in the Integumentary section, so typically the foreign body is at the skin level. On the other hand, the 2819X foot foreign body removal codes are listed in the Surgical section, so they often require a deeper location.