ED Coding and Reimbursement Alert

Question: I have a puzzling denial in front of me. The ED physician used a scalpel and tweezers to perform complicated splinter removal on a patient's left shoulder. Notes indicate that the subcutaneous removal was preceded by a level-two E/M service. I reported 24200 and 99282-25 and received a denial. Where did I go wrong? Answer: You should have chosen a more accurate code for the foreign body removal (FBR). When you re-submit the claim, report the following: 23330 (Removal of foreign body, shoulder; subcutaneous) for the FBR 99282 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; and medical decision making of low complexity ....) for the ED E/M service modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or [...]