General Surgery Coding Alert

Question:Our surgeon used a scalpel and tweezers to perform complicated splinter removal on a patient's left shoulder (880.10) in the emergency department. Notes indicate that the subcutaneous removal was preceded by a level-two E/M service. I reported 24200 and 99282 and received a denial. What did I do wrong?Washington SubscriberAnswer:You should have chosen a more accurate code for the foreign body removal (FBR). Based on the diagnosis code (880.10, Open wound of shoulder and upper arm; complicated, shoulder region) you should not use 24200 for this procedure. Also, you'll need a modifier to report the procedure and E/M together.When you re-submit the claim, report the following:23330 (Removal of foreign body, shoulder; subcutaneous) for the FBR99282 (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 ....) [...]