I know that you cannot bill a procedure for fish hook removal unless the physician makes an incision. Without an incision you would bill an E/M. My question is if the physician uses an 18 guage needle to enlarge the hole already made by the fish hook can this be considered an incision? He inserts the needle in the hole with the fish hook and wiggles it around until the hole is big enough to pull the fish hook out of. He cuts the barb off the fish hook first whenever possible. Rarely are sutures needed to close the wound. He says that the edges of the needle are very sharp and he considers this making an incision. I do not consider this an incision but I need to know for sure whether it is or isn't. There are several definitions of incision and they do not all specifically state that an incision must be made with a scalpal. Some say a sharp instrument/object. Can anyone help with this?