“I am having trouble finding an appropriate code to bill for a procedure to remove tophaceous material at a toe. The location was the left 2nd toe. This was performed in the office and a digital block was utilized to obtain anesthesia at the toe. Using a 3mm dermal curette, approximately 1 mL of tophaceous material was removed and a sterile gauze dressing applied. I planned to use ICD-10 M1A-0721. What CPT would be appropriate in this situation?”
The majority of the time, tophaceous deposits are found within a joint. Since the location of this tophaceous deposit that is stated within the above post was the left 2nd toe, there are two possible locations of the tophaceous material. The first is within the toe itself at either the proximal interphalangeal joint (PIPJ) or the distal interphalangeal joint (DIPJ) or at the metatarsophalangeal joint (MTPJ). If the tophaceous deposit/material was removed within the toe at the DIPJ or the PIPJ, the most appropriate CPT code to bill is 28024 which is defined as: Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal joint. If the tophaceous deposit/material was removed from the MTPJ, the most appropriate CPT code to bill is 28022 which is defined as: Arthrotomy, including exploration, drainage, or removal of loose or foreign body; metatarsophalangeal joint.
Therefore, if the tophaceous deposit was removed from the PIPJ or the DIPJ of the 2nd toe on the left foot, the appropriate CPT code to bill would be 28024 – T1. If the tophaceous deposit was removed from the 2nd MPJ on the left foot, the appropriate CPT code to bill would be 28022 – LT.
As far as the ICD-10-CM codes are concerned, this would not be an acute situation since a tophaceous deposit is present. Therefore, the most appropriate ICD-10-CM code to link to the CPT code that is billed would be M1A.0721: Idiopathic chronic gout, left ankle and foot with tophus (tophi).
This is my opinion.
Michael G. Warshaw, DPM, CPC
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