2nd example makes you wonder....
"So if a fish-hook is present in a patient's hand and the physician clips off one end and then removes the remainder with a hemostat, the service is considered packaged in the E/M service"
Q. We had a patient with a fish hook and barb in the palm of his hand. The doctor pushed the hook forward and advanced the barb through the skin. She then cut off the rest of the hook and then slid the hook out of the skin. How is this coded?
A. Some coders argue that since no incision was made, the hook removal is included in the E/M code. Others may hold that since the advancing of the hook made its own incision (howbeit less than 1 mm), one can use the code for subcutaneous foreign body removal with incision.
This may be a semantic distinction, as the so called "incision" is really just an iatrogenic puncture wound.
Prior to being aware of the coding implications, I generally made an incision in the skin to allow the tip of the advancing hook to slide though the skin. This technique makes the procedure simpler and less traumatic to the patient. In addition, the incision removes any controversy about whether the foreign body removal is compensable with the code 10120 (incision and removal of foreign body, simple).
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