Optimal Coding for Removing Multiple Splinters
Published on Sat May 01, 1999
Removing even one splinter from a child isnt easyand removing more than one is that much worse. Its a time-consuming process, and children, for some reason, are drawn to splinters like magnets. Takashi Yoshida, MD, of Sunnyvale, CA, writes to ask how to code for multiple splinter removal using a topical anesthetic such as EMLA cream.
We use the incision and drainage codes, says Pam Almandinger, billing specialist for the Pediatric Center, a six-pediatrician, one-nurse practitioner practice also in Sunnyvale, CA. The code Almandingers practice uses is CPT 10120 (incision and removal of foreign body, subcutaneous tissues; simple). This is a starred procedure, meaning that the code is for the surgery only, so technically you can use an office visit as wellbut only if you are doing more than just removing splinters. (See the box on this page for CPT verbiage on starred procedures.)
If the child was playing outside in the Southwest and had a run-in with a cactus, and you arent doing anything else but taking out those splinters, I wouldnt bill for anything but the 10120, the billing specialist says. But if the splinters have been in for a few days, or if an infection is setting in, you can bill for an office visit as well. This is because of the extra medical decision-making involved. Likewise, if, when you are removing the childs splinters, the mother mentions that she thinks the child might be getting an ear infection, and you do an exam for that as well, you can bill for an office visit in addition to the 10120, says Almandinger.
Is a modifier necessary? We always use modifier -25 when we use 10120 with an office visit, the billing specialist reports.
While Almandinger has never had any problems with insurance companies paying for 10120it has never been necessary to send doctors notes, and the claims get paid readilyone mother did complain about this code recently. Not that the mother was a coding expert, but the insurance policy happened to have a surgical deductible. That meant that the mother had to pay out of pocket for the office visit. She said that since we didnt use a scalpel, it couldnt be surgery, says Almandinger. But we use this code anytime we have to go beneath the skin for the splinter, even if its just with forceps. If the splinter is sticking above the skin and can be pulled out with tweezers, for example, you would only use an office-visit code. But if the tweezers go beneath the skin, thats 10120, opines Almandinger.
The problem with reimbursement for splinter [...]
