Try Your Hand at These Tick Removal Scenarios
Prepare to see more tick-related visits with summer amping up. As summer reaches its peak, it’s important to remember that kids are likely to come across ticks more frequently while engaging in outdoor adventures like hiking and camping. Due to their potential to transmit Lyme disease, ticks are a type of insect that parents typically prefer not to deal with by themselves when their child has one attached to them. As a pediatric coder, you're probably beginning to notice the yearly surge in cases of tick bites and related diseases by now. Take a look at a few tick removal techniques and how to code for Lyme disease testing to ready yourself for these pest-related presentations at your office. Provider Could Perform Removal Using Tweezers or Forceps For this scenario, let’s say an established 8-year-old patient comes into the office after a hiking trip presenting with a tick’s head buried, but the body visible. The provider sees that more than half of the tick’s body is evident, so they work with tweezers to remove the tick. The provider ends up spending 35 minutes using the tweezers, and finally is able to remove the tick successfully. Code the procedure: Since there isn’t a specific code for the tweezer removal, you should code this as 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.). Because this tick removal took a significant amount of time, it’s probably best to level this one on time spent rather than on medical decision making (MDM). In order to avoid a denial, be sure the practitioner has documented their time meticulously to account for it. Make sure their notes cover the following: How much time was spent evaluating the patient? Were there multiple angles or tools used to remove the tick? If there is no description of the procedure or significant supporting documentation to explain why so much time was spent on the procedure, you risk a denial. The Coding Changes for Removal by Incision In a scenario where the tick is barely visible and tweezers would cause more damage than necessary, let’s say the provider decides to go the route of removal by incision. The practitioner applies a topical anesthetic and uses a #11 blade to make a small incision to remove the tick. This method is quick and successful. Coding the procedure: For this scenario, you will need to report a foreign body removal (FBR) code. This means you’ll choose between 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (… complicated) because it describes a removal where the provider makes an incision in the patient’s skin to remove the foreign body, or in this case, the tick. Code 10120 is the easy choice in this scenario as the practitioner doesn’t mention anything about sutures or a complicated closure. Coding the diagnosis: For the tick bite, remember to report W57.XXX- (Bitten or stung by nonvenomous insect and other nonvenomous arthropods). Remember to add the 7th character: A (Initial encounter), D (Subsequent encounter), or S (Sequela) based on the episode of care. So, for these scenarios, because the physician is actively treating each patient, you would report W57.XXXA. Use These Codes for Lyme Disease Testing If your office is capable of testing for Lyme disease, you will likely see an uptick in requests for testing accompanied by tick bites. The Centers for Disease Control and Prevention (CDC) requires “a two-step testing process for Lyme disease serologic testing” that “can be done using the same blood sample.” They go on to elaborate that “If this first step is negative, no further testing is recommended. If the first step is positive or indeterminate (sometimes called “equivocal”), the second step should be performed. The overall result is positive only when the first test is positive (or equivocal) and the second test is positive (or for some tests equivocal).” For the CDC, “standard two-tier testing (STTT) uses enzyme immunoassay (EIA) as the first step and western blotting (WB) for the second step. Increasingly, laboratories are using modified two-tier testing (MTTT) in which both assays are EIAs.” Currently, you’ll report STTT for Lyme disease using the following CPT® codes: Check Out These Additional Lyme Test Codes CPT® lists several other tests you can use to detect the Borrelia burgdorferi antigen: Make note: The precision of these tests is highest when joint fluid, rather than blood, is used as the sample. Therefore, the antibody tests mentioned earlier, which are less invasive, are generally the favored method of testing. If a positive Lyme disease test result is returned, you would code A69.2- (Lyme disease). Lindsey Bush, BA, MA, CPC, Production Editor, AAPC
