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

Drawn from CMSJucmPodiatrymAAPCEmedny

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

22 Increased complexity 24 Unrelated E/M during global 25 Significant separate E/M 51 Multiple procedures 52 Reduced services 57 Decision for surgery 58 Staged or related 59 Distinct service 78 Unplanned return — related 79 Unrelated during global LT Left side RT Right side

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?

Complicating factors include multiple foreign bodies, significant contamination, extensive exploration (e.g., a 4 cm incision to locate the object), proximity to neurovascular or tendon structures, or organic material requiring thorough debridement. The operative note must name these factors — depth alone qualifies for 28192, not 28193.

02Can I bill a wound repair code alongside 28193 for closing the surgical incision?

No. Wound closure is bundled into 28193. Adding a repair code like 12002 will deny. If the closure was complex or required additional work, document it to support modifier 22 on the primary code rather than billing a separate repair.

03Should I append modifier 22 to 28193 for multiple foreign bodies?

You can, but weigh the tradeoff. Modifier 22 requires payer review and often delays payment without guaranteeing an increase. One podiatry coding source notes that in practice it frequently delays rather than increases reimbursement. Use it when the operative note clearly supports extraordinary work, and attach that documentation proactively.

04Is modifier 57 appropriate at the same visit when the physician decides intraoperatively — or at an E/M — to perform 28193?

Modifier 57 applies to an E/M visit on the day of or the day before a major surgery (90-day global) when that visit results in the decision to operate. If the complication requiring 28193 is identified during that visit, append 57 to the E/M, not to 28193 itself.

05How does 28193 differ from 20525 (deep or complicated foreign body in muscle or tendon sheath)?

28193 is specific to the foot and is the correct code when the foreign body is in foot tissue — even if near a tendon. Use 20525 when the foreign body is specifically within a muscle belly or tendon sheath and is not captured by the foot-specific codes. When in doubt, the foot-specific code (28193) takes precedence for foot locations.

06Does the 90-day global period affect how I bill follow-up care after 28193?

Yes. Routine post-op care through day 90 is included — don't bill separate E/M visits for normal wound checks. If a visit addresses a problem unrelated to the foreign body removal, append modifier 24 to the E/M. If a new and distinct procedure is performed for an unrelated reason, use modifier 79.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

Mira 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