How To Use CPT Code 28103

CPT 28103 describes the excision or curettage of a bone cyst or benign tumor in the talus or calcaneus, followed by the use of an allograft for repair. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 28103?

CPT 28103 is used to describe a surgical procedure in which a bone cyst or benign tumor in the talus or calcaneus is removed or scraped out. Following the excision or curettage, an allograft is harvested and implanted to repair the site. This code is specific to the excision or curettage of bone cysts or benign tumors in the talus or calcaneus, and the use of an allograft for repair.

2. Official Description

The official description of CPT code 28103 is: ‘Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft.’

3. Procedure

1. The procedure begins with the patient being appropriately prepped and anesthetized.
2. The provider makes an incision on the skin over the cyst or tumor in the ankle or heel.
3. He then dissects down through the subcutaneous tissue, taking care to protect the nerves and vessels.
4. The provider identifies the tumor or cyst in the talus or calcaneus bone.
5. He proceeds to excise the lesion from the bone.
6. Next, the provider harvests an allograft, which is a tissue graft obtained from a donor.
7. The allograft is then secured to the site where the tumor or bone cyst was removed.
8. The provider irrigates the wound with antibiotic solution to prevent infection.
9. Finally, he closes the wound in layers.

4. Qualifying circumstances

CPT 28103 is performed on patients with bone cysts or benign tumors in the talus or calcaneus. These conditions are typically non-cancerous and do not spread to other parts of the body. The procedure is carried out by a healthcare provider who is skilled in performing excisions or curettage of bone cysts or tumors. The use of an allograft for repair is a key qualifying circumstance for this code.

5. When to use CPT code 28103

CPT code 28103 should be used when a bone cyst or benign tumor in the talus or calcaneus is excised or curetted, and an allograft is used for repair. It is important to note that if an autograft is used instead of an allograft, CPT code 28103 should not be reported. In such cases, CPT code 28103 should be replaced with CPT code 28103, which describes the use of an autograft for repair.

6. Documentation requirements

To support a claim for CPT code 28103, the healthcare provider must document the following information:

• Patient’s diagnosis of a bone cyst or benign tumor in the talus or calcaneus
• Description of the procedure performed, including the excision or curettage of the cyst or tumor and the use of an allograft for repair
• Date of the procedure
• Details of the surgical approach and technique used
• Any complications encountered during the procedure
• Post-operative care instructions
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 28103, ensure that the procedure involves the excision or curettage of a bone cyst or benign tumor in the talus or calcaneus, followed by the use of an allograft for repair. If an autograft is used instead, CPT code 28103 should not be reported. It is important to follow the specific guidelines provided by the payer and use the appropriate modifiers if necessary.

8. Historical information

CPT code 28103 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes excision of a bone cyst in the talus, followed by the use of an allograft for repair.
2. A healthcare provider performs curettage of a benign tumor in the calcaneus, and an allograft is used to reconstruct the site.
3. During a surgical procedure, a bone cyst in the talus is excised, and an allograft is implanted to restore the bone.
4. A patient with a benign tumor in the calcaneus undergoes curettage, and an allograft is utilized for reconstruction.
5. A healthcare provider performs excision of a bone cyst in the talus, followed by the use of an allograft to repair the site.
6. During a surgical procedure, a benign tumor in the calcaneus is curetted, and an allograft is implanted for reconstruction.
7. A patient undergoes excision of a bone cyst in the talus, and an allograft is utilized to restore the bone.
8. A healthcare provider performs curettage of a benign tumor in the calcaneus, followed by the use of an allograft for repair.