Podiatry Coding & Billing Alert

Question: I'm having trouble pinning down a CPT code for a subungual exostectomy. I can only think of the debridement code 11044, but I don't think this is correct because the podiatrist didn't really debride the soft tissue; he just made a small incision at the tip of the distal phalanx of the great toe so he could rasp the bone smooth. What code should I use?

Maine Subscriber

Answer: You're correct in that this procedure does not take a debridement code such as 11044 (Debridement, bone [includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed]; first 20 sq cm or less) -- and your first hint is that the procedure is called an "exostectomy." This excision procedure fits under 28124 (Partial excision [craterization, saucerization, sequestrectomy, or diaphysectomy] bone [e.g., osteomyelitis or bossing]; phalanx of toe).

If the podiatrist had to excise or avulse the nail to access the subungual exostosis, do not bill for the nail procedures. National Correct Coding Initiative edits bundle them as components of 28124.