Soft tissue repair · Foot & ankle
Complicated removal of a foreign body from the foot, requiring extensive dissection or involving factors beyond a straightforward deep excision.
Verified May 8, 2026 · 7 sources ↓
- Medicare
- $511.03
- Work RVU
- 5.75
- Global, days
- 90
- Region
- Foot & ankle
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 7 cited references ↓
- Identify the specific complicating factors (e.g., multiple foreign bodies, extensive contamination, proximity to neurovascular structures, prolonged exploration)
- Document the anatomical depth reached during dissection — subcutaneous, deep, or subfascial/intramuscular
- Record the nature and type of foreign body removed (e.g., glass, metal, organic material, bone fragment)
- Document the approach and extent of dissection, not just 'standard approach' or 'foreign body removed'
- Note whether fluoroscopy or other imaging guidance was used intraoperatively to locate the foreign body
- Record wound closure method; separate closure codes are not billable but closure technique supports the complexity claim
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 7 cited references ↓
28193 covers foreign body removal from the foot when the procedure is complicated — meaning it involves extensive exploration, multiple foreign bodies, significant contamination, proximity to neurovascular structures, or other factors that elevate the work beyond what 28192 captures. The three codes in this family are hierarchical: 28190 (subcutaneous), 28192 (deep), and 28193 (complicated). Code selection depends on depth and complexity, not just anatomy. If the operative note documents a single, clean deep excision, 28193 won't hold up on audit — document the specific complicating factors explicitly.
Wound closure is bundled into 28193; don't add a repair code (e.g., 12002) for closing the surgical access. The 90-day global period applies, so routine post-op visits through day 90 are included. If a separate, unrelated procedure is performed during that window, append modifier 79. Modifier 22 can be appended when the work was genuinely extraordinary — multiple foreign bodies, prolonged exploration — but expect payers to require supporting documentation before paying up; some will simply delay rather than upcode.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (5.75) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (15.3) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 5.75 |
| Practice expense RVU | 9.02 |
| Malpractice RVU | 0.53 |
| Total RVU | 15.3 |
| Medicare national rate | $511.03 |
| Global period | 90 days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $511.03 |
HOPD (APC 5072) Hospital outpatient department | $1,687.37 |
ASC (PI A2) Ambulatory surgical center (freestanding) | $742.04 |
Common denial reasons
The recurring reasons claims for CPT 28193 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Operative note documents a routine deep excision without complicating factors, failing to support 28193 over 28192
- Wound repair code billed separately — closure is bundled into 28193 and will deny
- Modifier 22 appended without supporting documentation of extraordinary time or complexity, triggering payer audit or payment delay
- Claim submitted with mismatched ICD-10 diagnosis code that doesn't reflect a retained foot foreign body
- Post-op visit billed within the 90-day global period without modifier 24 or 25 when the visit is unrelated to the foreign body removal
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 7 cited references ↓
01What makes a foot foreign body removal 'complicated' enough to bill 28193 instead of 28192?
02Can I bill a wound repair code alongside 28193 for closing the surgical incision?
03Should I append modifier 22 to 28193 for multiple foreign bodies?
04Is modifier 57 appropriate at the same visit when the physician decides intraoperatively — or at an E/M — to perform 28193?
05How does 28193 differ from 20525 (deep or complicated foreign body in muscle or tendon sheath)?
06Does the 90-day global period affect how I bill follow-up care after 28193?
Sources & references
Editorial content was developed using the following public sources. Last verified May 8, 2026.
- 01CMS Physician Fee Schedule 2026
- 02jucm.comhttps://www.jucm.com/wp-content/uploads/2020/12/2007-2139-40-Coding.pdf
- 03podiatrym.comhttps://www.podiatrym.com/search3.cfm?id=4873
- 04aapc.comhttps://www.aapc.com/codes/cpt-codes-range/28190-28193/
- 05emedny.orghttps://www.emedny.org/providermanuals/physician/pdfs/physician%20procedure%20codes%20sect5.pdf
- 06abos.orghttps://www.abos.org/wp-content/uploads/2019/12/sports-cpt-updated.pdf
- 07cgsmedicare.comhttps://www.cgsmedicare.com/medicare_dynamic/j15/partb/ptpb/ptp.aspx
Mira AI Scribe
Mira's AI scribe captures the complicating factors from dictation — multiple foreign bodies, depth of dissection, contamination level, proximity to nerves or tendons, and intraoperative imaging use — and flags them in the operative note summary. This prevents downcoding to 28192 on audit and supports modifier 22 if the physician dictates unusually extensive exploration or time.
See how Mira captures CPT 28193 documentation