“I have a patient with a possible 1st proximal phalanx cyst vs infection that I plan to do an exploratory procedure and collect some bone cultures / swabs on. MRI was inconclusive.
If I get in there and the bone appears necrotic/infected, I will have on the consent form to allow for a PIPJ arthroplasty. So, we'll get prior auth for all these procedures prior to surgery.
But, for the initial planned procedure, how would this be coded?”
With respect to the exploratory procedure and collecting bone cultures/swabs, there really is not a CPT code for an “exploratory procedure.” As far as the bone cultures are concerned, the most appropriate CPT code for this would really be CPT code 20240 which is defined as the following:
Biopsy, bone, open; superficial (eg. sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx.
If the bone appears necrotic/infected, a PIPJ arthroplasty will be performed. When one performs an arthroplasty on the toe, immediately CPT code 28285 comes to mind. However, it is defined as the following: Correction, hammertoe (e.g. interphalangeal fusion, partial or total phalangectomy). Obviously, this is not the CPT code to use. The most appropriate CPT code to use for this scenario is CPT code 28124 which is defined as the following: Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (e.g. osteomyelitis or bossing); phalanx of toe.
Regarding the initial procedure that was performed, CPT code 20240, despite the fact that a specimen was obtained from the affected site to rule out a bone infection/osteomyelitis, when the “arthroplasty” was performed, the assumption is that the necrotic/infected bone will be submitted to the pathology lab for a bone culture to be performed in addition to pathological analysis. Based upon this premise, CPT code 20240 is not billable due to the fact that it is inclusive to CPT code 28124.
If CPT code 28124 is not performed and billed, then CPT code 20240 is billable and reimbursable.
This is my opinion.
Michael G. Warshaw, DPM, CPC
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