ED Coding and Reimbursement Alert

Expert Q & A to satisfy your curiousity--and your bottom line

Don't lose your anatomical place--or your practice's deserved reimbursement--with tough foreign-body removal (FBR) cases. The type of removal and method may vary from patient to patient, but these field-tested answers will help you with the full range of possibilities.

Question: Should the instrument the doctor used determine which code I choose when the physician performs an FBR in the cornea or conjunctiva of a patient's eye?

Answer: Sometimes. For conjunctival foreign bodies, you will use code 65205 (Removal of foreign body, external eye; conjunctival superficial) or 65210 (... conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating), and these codes do not indicate any particular instrument for removing the FB. You should choose a code according to the specific location and level of penetration of the FB in the eye.

For example, for the removal of a superficially penetrating FB in the conjunctiva, you would report 65205. The physician may use a cotton swab, needle, burr or other instrument, but this does not affect code choice.

Not so fast: If your physician performs an FBR in the cornea, you will need to consider the visualization equipment involved: that is, whether he uses a slit lamp to visualize the FB. Report 65220 (Removal of foreign body, external eye; corneal, without slit lamp) if the physician did not use the slit lamp; otherwise, report 65222 (... corneal, with slit lamp).

Method can matter: For most procedures in the ED, CPT does not specify which method the physician must use. But for those done elsewhere, there can be some variations. In addition to the examples above, there are other times when the FBR method will dictate your code choice.

For example, suppose a mentally handicapped patient has accidentally swallowed a small battery. Your physician may use an endoscope to remove the foreign body from the patient's stomach. If so, you would report 43247 (Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with removal of foreign body). Question: How should I code if my physician performs a significant exploration of a penetrating traumatic wound, such as a gunshot to the extremity?

Answer: In this case, your physician is exploring the wound to assess and treat possible injuries to  critical neurovascular structures, rather than a foreign-body removal.

Example: A patient presents with a small-caliber gunshot wound to the lower leg, and your physician explores the wound to evaluate for any damage to underlying nerves and blood vessels. Because this is a penetrating wound (gunshot, knife and some dog-bite wounds fit in this category), you should report 20103 (Exploration of penetrating wound [separate procedure]; extremity).
 
Note: Even if the provider had removed an FB during wound exploration, you [...]