Pediatric Coding Alert

ICD-10 2024:

Reach Into ICD-10 2024 to Find 173 New Foreign Body Codes

Published on Wed Aug 09, 2023

Also: review the FBR codes to use with them.

Kids love to explore the world around them, but sometimes parts of that world end up lodged where they don’t belong. As pediatric coders, you’ve surely found yourself trying to code encounters like this, and the 2024 ICD-10 revisions will make it easier for you to do so.

Effective October 1, 2023, you’ll have 173 new codes at your disposal found under W44 (Foreign body entering into or through a natural orifice). Let’s run through these new codes and review the procedure codes that correspond to how your provider handles these encounters.

Familiarize Yourself With the W Codes

ICD-10’s new W codes are going to make it a lot easier to code a common pediatric encounter. “Often, when patients’ little fingers got a hold of something they should not have… an item ends up in a place it should not,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/ auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “These codes will help us identify the specific object for clearer documentation,” she continued.

The codes are broken down by the material that makes up the foreign body:

Batteries: One of the more potentially dangerous materials is represented with W44.A- (Battery entering into or through a natural orifice):

W44.A0- (Battery unspecified …)
W44.A1- (Button battery …)
W44.A9- (Other batteries …)

Plastic: When a patient has inserted an object made of plastic, you’ll select from the following W44.B- (Plastic entering into or through a natural orifice) codes:

W44.B0- (Plastic object unspecified …)
W44.B1- (Plastic bead …)
W44.B2- (Plastic coin …)
W44.B3- (Plastic toy and toy part …)
W44.B4- (Plastic jewelry …)
W44.B5- (Plastic bottle …)
W44.B9- (Other plastic object …)

Glass: The following are for use when glass is the foreign body, reported as W44.C- (Glass entering into or through a natural orifice)

W44.C0- (Glass unspecified …)
W44.C1- (Sharp glass …)
W44.C2- (Intact glass …)

Magnetic and non-magnetic metal: ICD-10 has created codes that distinguish between magnetic W44.D- (Magnetic metal entering into or through a natural orifice) and nonmagnetic W44.E- (Non-magnetic metal entering into or through a natural orifice) metals to help you more accurately specify the material and potentially also the severity of the situation:

W44.D0- (Magnetic metal object unspecified …)
W44.D1- (Magnetic metal bead …)
W44.D2- (Magnetic metal coin …)
W44.D3- (Magnetic metal toy …)
W44.D4- (Magnetic metal jewelry …)
W44.D9- (Other magnetic metal objects …)
W44.E0- (Non-magnetic metal object unspecified …)
W44.E1- (Non-magnetic metal bead …)
W44.E2- (Non-magnetic metal coin …)
W44.E3- (Non-magnetic metal toy …)
W44.E4- (Non-magnetic metal jewelry …)
W44.E9- (Other non-magnetic metal objects …)

Natural and organic materials: The following W44.F- (Objects of natural or organic material entering into or through a natural orifice) codes cover a variety of miscellaneous natural materials:

W44.F0- (Objects of natural or organic material unspecified …)
W44.F1- (Bezoar …)
W44.F2- (Rubber band …)
W44.F3- (Food …)
W44.F4- (Insect …)
W44.F9- (Other object of natural or organic material …)

Non-organic materials: W44.G- (Other non-organic objects entering into or through a natural orifice) covers several non-organic objects as well as combinations of materials:

W44.G0- (Other non-organic objects unspecified …)
W44.G1- (Audio device …)
W44.G2- (Combination metal and plastic toy and toy part …)
W44.G3- (Combination metal and plastic jewelry …)
W44.G9- (Other non-organic objects …)

Sharp objects: Report W44.H- (Other sharp object entering into or through a natural orifice) when the material is sharp (except for glass).

W44.H0- (Other sharp object unspecified …)
W44.H1- (Needle …)
W44.H2- (Knife, sword or dagger …)

Other and Unspecified: Be on the lookout for an “other” and “unspecified” code in this new set aslo. You’ll have W44.8- (Other foreign body entering into or through a natural orifice) and W44.9- (Unspecified foreign body entering into or through a natural orifice) available to choose from. Remember that “details known at the time of the encounter should drive the choice between the ‘Other’ and ‘Unknown’ code varieties that are available. ‘Other’ should be reported when there are known details for which there is no specific code descriptor. ‘Unknown’ is for use when details are not available at the time of encounter to make a specific choice,” explains Jan Blanchard, CPC, CPEDC, CPMA, pediatric solutions consultant at Physician’s Computer Company in Winooski, Vermont.

Coding alert: Each of these codes requires a 7th character representing the encounter type as follows:

A: initial encounter
D: subsequent encounter
S: sequela

Remember How to Report the Removal

In some cases, the pediatrician will be able to remove the foreign body during one of the encounters. Before determining which code to use for that, first determine how the material was removed.

No incision: If the pediatrician does not make an incision, and instead removes the material using tweezers or another implement, it would be considered part of an evaluation and management (E/M) visit.

If the procedure is simple enough to be done safely in the office, the patient’s complaint can be regarded as an acute, uncomplicated illness, defined by CPT^® as “a recent or new short-term problem with low risk of morbidity for which treatment is considered,” and for which “there is little to no risk of mortality with treatment, and full recovery without functional impairment is expected.” Additionally, the foreign body removal (FBR) itself presents a low risk of morbidity to the patient. These two low elements of medical decision making (MDM) combine to give an overall low MDM, enabling you to easily justify billing 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.) for the visit.

Incision: In the unlikely event the FBR turns from an E/M to a removal by incision, or if your pediatrician immediately uses a scalpel or other sharp instrument to help remove the foreign body in the encounter, two procedure codes may then come into play: 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (… complicated).

Note: If the pediatrician used the term “complicated” in the documentation, you can go with 10121. If you’re ever unsure whether a FBR is simple or complicated, query the provider.

Here are a few other codes to consider for FBR:

30300 (Removal foreign body, intranasal; office type procedure)
30310 (Removal foreign body, intranasal; requiring general anesthesia)
65205 (Removal of foreign body, external eye; conjunctival superficial)
69200 (Removal foreign body from external auditory canal; without general anesthesia)

Consider the New Foreign Body Sensation Codes

ICD-10 is also adding a handful of codes to help you report when a patient comes in complaining of the sensation of a foreign body in the eye but the examination finds no such object. The following codes will be added to the H57.8- (Other specified disorders of eye and adnexa) code set:

H57.8A (Foreign body sensation eye (ocular))
H57.8A1 (Foreign body sensation, right eye)
H57.8A2 (Foreign body sensation, left eye)
H57.8A3 (Foreign body sensation, bilateral eyes)
H57.8A9 (Foreign body sensation, unspecified eye)

Similarly, ICD has expanded R09.- (Other symptoms and signs involving the circulatory and respiratory system) to account for patient complaints of a foreign body feeling in other orifices: