Otolaryngology Coding Alert

Reviewed on May 21, 2015
  Question: How should we code an incision to remove the back of an earring embedded in the patient's earlobe?

New Jersey Subscriber
Answer: Although the first place one is likely to look is the 69000 series of codes (which describe most procedures involving the ear), the only codes for removal of foreign body in the external-ear section pertain to the auditory canal and not to outer ear areas.
 
The correct codes are in the 10000 series.
 
Musculoskeletal codes do not apply to the earlobe, which consists of skin and subcutaneous tissue. In this case, the earring part was embedded in the subcutaneous tissue. CPT includes two removal-of-foreign-body codes among the incision and drainage (I&D) codes in this section: 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) and 10121 (… complicated). Depending on the circumstances, one of these two codes should be reported.   
If the removal is complicated and 10121 is reported, a complex repair of the wound may be reported separately using codes 13150 (Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or less) or 13151 ( 1.1 cm to 2.5 cm), as appropriate. It is unlikely that an earlobe repair, however complex, could be larger than 2.5 cm.
 
Note: Code 10121 should be used for the removal of multiple foreign bodies in the lobe. The term "complicated" refers not only to the depth of the incision but to any factor, such as multiple foreign bodies, making the incision and removal difficult. A return to the operating room to remove the foreign body would also qualify as a complicated incision and removal, necessitating 10121.