Pull Correct FBR Claims Each Time With This Advice
Do you know when an ED E/M becomes an FBR? It’s spring again, which means rebirth, regrowth, and people reporting to the emergency department (ED) more often for foreign body removals (FBRs). Whether it’s wood splinters, glass, or some other object, FBRs seem to ramp up at EDs as the temperature rises. For coders, this means making a couple of coding decisions: namely, whether the service meets the CPT® definition of FBR and, if it doesn’t, how to correctly report the encounter. Don’t stress, because we have the answers you need to make FBR coding quick and painless. FBR Will Begin With E/M You should know that just because the ED physician removes a foreign body, it might not classify as a separately codeable FBR. How? The ED physician might clear up the patient’s problem during the evaluation and management (E/M) portion of the service. When the ED physician sees the patient initially, they’ll have to conduct a history and physical examination in order to gauge the severity of the patient’s problem and medical history. You’ll report this E/M service with a code from the 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making) code set. If the physician removes the foreign body without making an incision — as they might when using only tweezers or forceps — then you cannot consider the service a codeable FBR. Example: A patient presents to the ED after getting a foreign body lodged in their upper left arm. The physician examines the wound, then cleans and preps the area. The physician then uses a pair of forceps to grip and pull out the foreign body. There is no mention of an incision. For this encounter, the physician didn’t make an incision. You should report the service with the appropriate-level ED E/M code. Don’t forget to append S40.852A (Superficial foreign body of left upper arm, initial encounter) to the ED E/M code to represent the patient’s injury. Simple FBR Means This Code + E/M-25 Coders need to be on the lookout for clues in the notes that an incision may have been made, because if there’s an incision then you move from an FBR covered with an ED E/M code to a separately codeable FBR. If the ED physician performs an FBR using incision, you should report 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) for the service. You can also code any ED E/M service the physician provides in addition to the FBR separately with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended. Example: A patient presents to the ED after “stepping on something sharp while barefoot.” The wound is on the ball of the patient’s right foot; they report pain and difficulty walking, and there is mild swelling around the injury. After a history, physical, and examination, the physician preps the patient’s heel with 1 percent lidocaine to numb the area. The physician then uses a sterile number 11 scalpel to cut near the foreign body and exposes a 1.1 cm wood splinter. Using fine-tipped tweezers, the ED physician pulls the splinter out. Encounter notes indicate a level 3 ED E/M preceded the FBR. In this encounter, the physician clearly made an incision to perform the FBR. On the claim, report: Be Careful With Complicated FBRs There is also a complicated FBR code, 10121 (… complicated). It is not the easiest code to employ successfully, however. Why? CPT® doesn’t define a complicated FBR for coding purposes. There are any number of reasons an FBR might become complicated: delayed treatment, infection, removing multiple foreign bodies, debridement, wound exploration, etc. However, unless the ED physician explicitly states that the FBR was complicated, you can’t report 10121. Coders simply aren’t equipped with the knowledge to distinguish the difference between a simple and complicated FBR. These FBR Codes Are Also Possible in the ED The 20100 (Exploration of penetrating wound (separate procedure); neck) through 29999 (Unlisted procedure, arthroscopy) musculoskeletal surgery code set contains numerous FBR codes specific to anatomic areas. These codes are employed when the physician has to put in extraordinary effort to perform the FBR or if the removal involves the fascia. These types of procedures are unlikely in the ED, but if you think an FBR may warrant one of these codes, query the physician to see if you should code it this way. Have Query Questions Ready Just in Case As you’ve probably perceived, there are numerous instances where you might have to query the physician when coding an FBR encounter. If it isn’t clearly indicated, you might not know if the physician made an incision or not. Without an incision, the FBR is only coded with an ED E/M. You also might need to query the ED physician about the type of FBR. If the FBR appears complicated and they don’t indicate that in the notes, you’ll need to check with the physician if you want to consider 10121. You will also have to make queries if you consider using the FBR codes contained in the 21000-21999 code set. Best bet: Make respectful queries to the ED physician about any aspects of the encounter that aren’t clear in the documentation. Chris Boucher, MS, CPC, Senior Development Editor, AAPC
