Primary Care Coding Alert

Question: Our FP removed glass from a patient's temporal area and sutured the wound. We billed 10120 for the foreign-body removal and 12011 for the simple repair. The insurance company denied the 12011, saying we can only use the code that encompasses both foreign-body removal and repair. Which code is that? Maine Subscriber Answer: Most insurance companies consider 10120* (Incision and removal of foreign body, subcutaneous tissues; simple) to include the repair, just as CPT states that excision of skin lesions (11400-11446 and 11600-11646) includes simple closure or repair. The "Coder's Desk Reference" says the following about 10120: "A foreign body becomes embedded in the subcutaneous tissues. The physician makes a simple incision in the skin overlying the foreign body. The foreign body is retrieved using hemostasis or forceps. The skin may by sutured or allowed to heal secondarily."

This passage suggests that 10120 encompasses both removal and repair. If you remove the 12011* (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) from your claim, you will be appropriately reimbursed for the 10120.

If the procedure is more complicated for example, it requires dissection of the underlying tissues use 10121 (... complicated). The physician in your case most likely provided an E/M examination in addition to the foreign-body removal. Because 10120 is a starred procedure, which means it only includes the surgical procedure, you can bill separately for the E/M. Report the appropriate-level E/M office visit code, the 10120, and append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to show that it is separate from the foreign-body removal.