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The CPT® Code 28047 refers to the radical resection of a tumor located in the soft tissue of the foot or toe, specifically when the tumor measures 3 cm or greater. Soft tissues encompass a variety of structures, including muscles, tendons, fat, blood vessels, lymph vessels, nerves, and the tissues that surround joints. Tumors found in these soft tissues can be classified as either benign or malignant. However, radical resection is predominantly indicated for malignant neoplasms, such as sarcomas, although it may also be necessary for benign tumors or those of uncertain nature. The procedure begins with the creation of a skin incision directly over the tumor, or alternatively, a skin flap may be elevated to access the tumor. Following this, the overlying tissue is carefully dissected to expose the tumor. The surgical goal is to remove the tumor en bloc, which means excising it along with a wide margin of healthy surrounding tissue to ensure complete removal. This radical resection may involve the excision of all affected soft tissue, which can include critical structures such as muscles, nerves, and blood vessels. To confirm that all cancerous cells have been removed, a frozen section analysis is performed on the excised margins. If any malignancy is detected at the margins, further tissue is excised until clear margins are achieved. Post-surgery, drains may be placed as necessary to manage fluid accumulation, and the surgical wound can be closed in layers. In some cases, additional reconstructive procedures may be required and reported separately. It is important to note that for tumors smaller than 3 cm, the appropriate code to use is 28046, while CPT® Code 28047 is specifically designated for tumors measuring 3 cm or greater.
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The radical resection of soft tissue tumors in the foot or toe, as described by CPT® Code 28047, is indicated for the following conditions:
The procedure for radical resection of a soft tissue tumor in the foot or toe involves several critical steps:
After the radical resection procedure, patients may require specific post-operative care to ensure proper healing and recovery. This may include monitoring for signs of infection, managing pain, and ensuring that drains, if placed, are functioning correctly. Patients are typically advised on activity restrictions to allow the surgical site to heal adequately. Follow-up appointments are essential to assess the surgical site, review pathology results from the excised tumor, and determine if any further treatment is necessary based on the tumor's characteristics.
| Short Descr | RESECT FOOT/TOE TUMOR 3 CM/> | Medium Descr | RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE 3 CM/> | Long Descr | Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; 3 cm or greater | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P3D - Major procedure, orthopedic - other | MUE | 1 | CCS Clinical Classification | 160 - Other therapeutic procedures on muscles and tendons |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service | T1 | Left foot, second digit | TA | Left foot, great toe | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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