ED Coding and Reimbursement Alert

The physician must decide if the procedure is simple or complicated Appropriate reporting of foreign-body removal (FBR) can vary greatly depending on the type of foreign body, its anatomic location, and the depth from which the physician must remove it. Here are five case studies to help you find your way. Case #1: No Incision Means No Separate FBR The situation: While operating a metal lathe, the patient embeds several small metal filings in his shoulder. The physician inspects the wounds and, using tweezers, extracts the shards.

The solution: Because the physician did not create a separate incision to remove the foreign bodies, you cannot code an FBR. Rather, you should include the removal of the metal filings as a component of whatever E/M service the physician documents (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient ...).

The -what if- scenario: The patient received deep wounds when he was hit from flying debris from an exploding propane tank. The physician explores the open wounds, removes several pieces of debris, and debrides and closes the wounds.

In this case, the physician performed wound exploration (20100-20103) with removal of the foreign body, which you should report using the wound exploration code that best describes the anatomic location of the wound the physician explored (such as 20101, Exploration of penetrating wound [separate procedure]; chest). Removal of foreign bodies is included in wound exploration codes.
 
Case #2: Turn to Integumentary Codes for Removal Just Beneath Skin The situation: The physician removes a small metal pellet embedded underneath the skin.

The solution: In this case, because the removal occurs from just beneath the skin, you should turn to 10120 (Incision and removal of foreign body, subcutaneous tissues; simple).

The -what if- scenario: As above, the physician removes a small metal pellet embedded beneath the skin, but in this case the wound is severely infected. In this case, the better code choice may be 10121 (- complicated).

Whether you should choose the -simple- or -complicated- code depends on your physician's clinical judgment: If the wound is infected, as in this case, or shows other complications, 10121 may be more appropriate than the -simple- code 10120. Case #3: For Deeper Removal, Look to Musculoskeletal Codes The situation: The patient in case study #1 removes the metal filings himself. After several weeks, his wounds heal, but one metal filing remains and has now become imbedded beneath the skin and into the muscle. The physician sees the patient and, through an incision, removes the foreign body from the patient's shoulder.

The solution: When reporting FBR from a musculoskeletal site (muscle or even bone), you must select the correct FBR code by anatomic location and depth.

The musculoskeletal [...]