Outpatient Facility Coding Alert

Reader Questions: Choose 28090 for Removing Ganglion Cyst from Foot


- Published on Wed, Apr 04, 2012

Question: The surgeon removed a ganglion cyst that was over the sinus tarsi area of the patient's foot. For the facility, should I report 27630 if he made a subcutaneous incision?


Answer: Although 27630 (Excision of lesion of tendon sheath or capsule [e.g., cyst or ganglion], leg and/or ankle) is a valid code for a freestanding or hospital-based facility, it's not your best choice in this situation. Because the cyst was on the patient's foot, choose 28090 (Excision of lesion, tendon, tendon sheath, or capsule [including synovectomy] [e.g., cyst or ganglion]; foot).
If you're coding for a freestanding facility, the national facility rate for 28090 is $891.60, and the procedure falls under payment indicator A2 (Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight). For hospital-based OPPS coding, procedure 28090 is under APC classification 0055 (Level I foot musculoskeletal procedures). [...]

Outpatient Facility Coding Alert
Issue - Apr, 2012
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