ED Coding and Reimbursement Alert

If the removal does not meet procedure-code standards, report an E/M Emergency department physicians are often called on to perform soft-tissue foreign-body removal (FBR) procedures -- especially in the summer months, when the warm weather results in more outdoor work and play. 
 
Reporting soft-tissue FBRs involves more than one code choice, so knowing exactly what constitutes an FBR -- and what doesn't -- is key if you want to file an accurate claim.
 
Confusion often arises when coders look at the notes and start asking themselves, -What constitutes a [foreign-body] removal?- says Linda Martien, CPC, CPC-H, coding specialist for National Healing Inc. in Boca Raton, Fla.
 
Try this: According to Robert LaFleur, MD, FACEP, of Medical Management Specialists in Grand Rapids, Mich., when you are considering whether or not an encounter was an FBR, you-ll need to determine:

 - the complexity of the removal
 - whether the physician performed an incision during the procedure
 - the anatomical location of the removal. Once you-ve addressed these issues, you should be prepared to pick the proper FBR code. Most ED Removals Are Simple
 
ED coders should first decide whether the procedure was a simple or complex removal. For a simple soft-tissue FBR, you would report 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) for the encounter.
 
Consider this example, courtesy of Martien: A carpenter presented with a nail embedded in his right thigh; he accidentally shot himself with a compressed-air nail gun. The nail is buried in the skin and subcutaneous tissues, and the nail head is palpable under the skin.
 
The ED staff cleaned and prepped the wound, and the physician anesthetized the injury site. He then cut a tiny -X- over the nail head and used forceps to grip the nail and remove it. Staff then cleaned the wound again and applied antibiotic ointment. The physician closed the incision with a Steri-Strip and applied a dry dressing.
 
On the claim, you should:
 - report 10120 for the nail removal.
 - link ICD-9 code 890.0 (Open wound of hip and thigh; without mention of complication) to 10120 to represent the patient's injury.
 - link E920.1 (Accidents caused by cutting and piercing instruments or objects; other powered hand tools) to 10120 to represent the accidental cause of the patient's injury. (Use E920.1 to represent injuries caused by any powered hand tool powered by compressed air such as our nail gun.)
 
Diagnosis coding matters: When you submit a claim for soft-tissue FBR, the payer will be scrutinizing your choice of diagnosis codes, Martien says. In the above example, you must code the injury, and the E codes are also helpful for added accuracy in describing the accident.
 
Exception: Most of your soft-tissue FBRs in the ED will be simple. However, if your [...]