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28090 ganglion cyst foot, resection of bony boss first metatarsal/cuneiform

Tanesha Posted Tue 10th of March, 2020 18:24:30 PM
Should I apply a code for the bony prominence removal? It doesn't seem a separate incision was made. Op Excerpt: A longitudinal incision was then made on the dorsal aspect of the foot over the mass incorporating the previous incision. The extensor tendon EHL was identified and retracted. Neurovascular structures were protected and the cyst/mass identified and removed in its entirety. It seemed to originate from the first metatarsal-cuneiform joint. Due to the bony prominence in this area, bur was used, followed by a rasp to smooth this out and shave it
SuperCoder Answered Wed 11th of March, 2020 10:14:19 AM



Thanks for your question.


As per the limited documentation available, the documentation suggests that the cyst/mass seemed to be originated from first metatarsal-cuneiform joint. Therefore, if the cyst is bony then code 28104 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus  may be appropriate to use.


If the cyst is ganglion then code 28090 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot is appropriate to use.


Also, modifier 22 increased procedural services may be appended with code 28090 since the provider shaved off the bony prominence if the criteria for the modifier 22 is fulfilled:


In order to append modifier 22 to a surgical procedure, check that the physician documented the reason(s) why the work he performed was more than he typically performs, and the documentation should include any or all of the following:

–Increased intensity

–Additional time

–Technical difficulty

–Severe patient condition, which causes the surgery to be difficult, dangerous to the patient, and requires additional physical and mental effort from the physician.


Hope this helps.



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