Wiki Foreign body removal

[aekenyon87]

Hello,

We have a patient's parent disputing a procedure that was billed for the visit. Jellybean was stuck in right nare & CPT 30300 was billed. The provider was going to use tweezers to remove the jelly bean, but decided to first examine the area of concern once more. After wiping the patient's nose, the jelly bean fell out. Per the provider's documentation under procedure details- direct visualization, near nare opening/pressure placed above w/ complete removal; simple procedure complexity. No imaging or topical anesthetic done.

Does the provider have justification to bill CPT 30300? Or would this just be included in the E&M code?

Thanks!

 

[michellepilcher]

CPT description: The physician removes a foreign body from the inside of the nasal cavity, in the office for 30300 or under general anesthesia for 30310. Foreign bodies are defined as objects not normally found in the body. An object may be embedded in normal tissue as a result of some type of trauma. Topical vasoconstrictive agents and local anesthesia are applied to the nasal mucosa. A small incision may be necessary to access the foreign body. Blunt dissection and retrieval of the object is performed with hemostats or forceps. Sutures may close the mucosa in a single layer if the size of the dissection requires.

Wiping the nose and the object falling out does not qualify as the procedure reported.

 

[Pathos]

CPT description: The physician removes a foreign body from the inside of the nasal cavity, in the office for 30300 or under general anesthesia for 30310. Foreign bodies are defined as objects not normally found in the body. An object may be embedded in normal tissue as a result of some type of trauma. Topical vasoconstrictive agents and local anesthesia are applied to the nasal mucosa. A small incision may be necessary to access the foreign body. Blunt dissection and retrieval of the object is performed with hemostats or forceps. Sutures may close the mucosa in a single layer if the size of the dissection requires.

Wiping the nose and the object falling out does not qualify as the procedure reported.

Agreed, this should be a regular E/M visit.