Primary Care Coding Alert

Gain $54-225+ when you identify these items. Automatically accepting an E/M code or rejecting an E/M-25 or emergency add-on opportunity may cost you $54-161 in non-eye foreign-body removal (FBR) and $64+ in FBR-related payment. Safely boost your pay using this action plan. Step 1: Spot Anatomic Code If your FP circles 99201-99215 when she removes a foreign body, let her know there's a higher-paying way. Stick with skin FBR code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) (3.41 relative value units [RVUs]) when the FP removes an object using a simple incision. Beware: Throughout the CPT manual, you can also find several codes for foreign-body removal from specific sites. If a provider removes an FB from one of these places, opt for the site-specific FBR code, such as: These minor procedural codes pay $54-$161 more nationally than 99213 (Office or other outpatient visit for the evaluation and management of an established patient -) (1.68 RVUs, $64), using the 2008 Medicare Physician Fee Schedule. Example: To remove a piece of glass from a patient's finger, an FP uses a scalpel to cut into the subcutaneous tissues of a patient's finger. Using 10120 instead of 99213 will net approximately $66 more in pay. Speed tip: You can find anatomic FBR codes in the CPT index under "Foreign Body Removal" and "Removal, Foreign Body". If these headings don't list the affected area, look under the anatomic area and then "removal." For instance, to find the removal code for foot, you have to look up "Foot," and then go down to "Removal: Foreign Body" to locate the foot FBR code (28190). Step 2: Add on E/M-25 for Above and Beyond Don't forget to add on an office visit, when appropriate. "You would report an E/M in addition to FBR if the E/M was over and above the FBR," says Penny Osmon, CHC, CPC, CPC-I, PCS, coding and reimbursement educator for the Wisconsin Medical Society in Madison. Reporting E/M-25 indicates either the physician evaluated and managed the patient for another problem or condition, or the examination and management resulted in a separate decision to perform the FBR. Example: A mother complains that her child has bad breath. An examination of the pharynx reveals a stuck fish bone. The physician uses tongs to remove the bone. You should report 42809, which will pay approximately $99 more than 99213. Because the physician had to provide an E/M service prior to finding and then removing the foreign body, you should report an office visit appended with modifier 25 in addition to the FBR code. "If the reason for the visit was focused solely on removing the foreign body, no E/M would be appropriate," Osmon cautions. [...]