Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

excision of ganglion cyst and bone spur, foot mass

Tanesha Posted Tue 02nd of June, 2020 08:35:42 AM
Can I code both? 28090 and 28104 Excerpt: A longitudinal incision was made directly over the mass. The common extensor tendons were identified. The neurovascular bundle was identified. Superficial nerves were identified and the mass was exposed and removed in its entirety using dissection and cautery. It had the appearance of a ganglion cyst. It was in the area of cuneiform 2 and 3 and using a rongeur and rasp, multiple bone spurs in this area were gently removed and smoothed out. She then had a large mass over the dorsal aspect of the navicular. The incision was extended proximally, anterior tib tendon was identified. The EHL was identified and again the neurovascular structures were protected and this mass was exposed and rongeured down to a smooth border.
SuperCoder Answered Wed 03rd of June, 2020 03:54:52 AM

Hi Tanesha,

AAE does not provide coding/auditing/reviewing for operative reports and chart notes.

SuperCoder offers SuperCoding on Demand (SOD) ( for coding of an operative report or chart note and you can contact (866)228-9252 or e-mail for more information.

On coding of CPT 28090 {Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot} and 28104 (Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus): There is no CCI edits bundling between both the codes, but it is suggested when both the procedures are performed on the same anatomical location, then do not bill those together. However, modifier 22 (Increased Procedural Services) can be appended with the primary procedure. CPT 28104 has the higher dollar value, so you can append modifier 22 with it when the procedures are done on same anatomical location and provider took longer time and efforts to perform the procedure. On the other hand, if the anatomical locations for both the procedures are different, then these codes can be billed together.

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

An unusual procedure is not when the physician took only a few extra minutes on the patient’s case or when the physician documents that the procedure was only slightly more difficult. There is an average range of difficulty for every procedure. A procedure could be slightly more difficult and still meet the definition of the procedure and not warrant appending modifier 22.

Hope this helps!

Related Topics