11/30/2021
Correct Billing for Excision of Soft Tissue-28043
How do you bill for excision of soft tissue 28043 RT DX: D21.21 or M21.9 or do you know of another code Either keeps being denied. inappropriate procedure/dx code.
28043: Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm
For the removal of a neoplasm, there is no specific policy that outlines the medical necessity of the surgical procedure. In addition to the two ICD-10 codes listed in the inquiry, the following ICD-10 codes should be considered when this procedure is performed:
- C76.5X (Malignant neoplasm of lower limb)
- D09.8 (Carcinoma in situ of other specified sites)
- D36.13 (Benign neoplasm of lower limb, including hip)
- D48.1 (Neoplasm of uncertain behavior of connective and other soft tissue)
- D48.5 (Neoplasm of uncertain behavior of skin)
- D48.7 (Neoplasm of uncertain behavior of other specified sites)
The diagnosis codes listed above do not guarantee payment for the surgical procedure. If the local continues to deny the procedure for medical necessity, office notes or op-reports should be submitted to justify the coding submitted, supporting documentation that justifies medical necessity should reverse a denial for the surgery if the union will not pay based on the coding reported on the claim.