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Thread: Foreign Body Removal

  1. #1

    Default Foreign Body Removal

    If a patient comes into the office and the physician performs a small "exploration" of the hand to look for a retained foreign body (splinter), but none was found. Can we still use 10120 (incison and removal of foreign body, simple) even though no foreign body was found? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  2. #2

    Default I think not

    I would say no, since your physician did not perform a removal. The CPT code states "incision and removal of foreign body".

  3. #3

    Default

    Thanks, so would the exploration be included in the E/M code then?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  4. #4

    Default

    Have you considered coding 10120 with modifier 52? If the clinician performs an incision and exploration and intends to remove a foreign body, that would seem more appropriate. It is most likely that a procedure is documented rather than E&M elements. What do you think?

  5. #5
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    Default

    I agree that the surgeon deserves to get more than just an e/m visit for the incision and attempted removal.

  6. #6
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    Default Concur w/ 52 modifier

    I agree with JahodaTV's thinking ... the intention was to remove a foreign body and the documentation probably is more in line with the procedure. Since no FB was found, putting the 52 modifier on 10120 makes sense to me.

    F Tessa Bartels, CPC, CPC-E/M

  7. #7
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    Default splinter

    If you follow the logic of this then 10120 -52 would be appropriate.

    Subject Use 10120 for tick and splinter removal if you have to go ‘digging'
    Source Coder Pink Sheets
    Effective Date Aug 1, 2007
    Publish Date Aug 1, 2007

    Use 10120 for tick and splinter removal if you have to go ‘digging’
    If you automatically circle the lowest level E/M for removing a tick or splinter – but nothing else – you may be shortchanging yourself.
    Yes, the most minor foreign body removals – where you simply pluck the object from the skin – will be coded only as an E/M. These are usually so simple that parents could even handle them on their own if they were so inclined.
    But once the patient is in your office, the tick or splinter may have become more difficult to remove. Perhaps the tick buried itself deeper in an attempt to evade the parental “surgery,” or perhaps Mom and Dad pulled off only the head or the top portion of a deep splinter. That extra work might mean you’ll report a code from the integumentary section of the CPT book. Furthermore, you may be able to bill an E/M in addition to the relatively well-paying integumentary code.
    For removing the tick or splinter from skin, use 10120 (incision and removal of foreign body, subcutaneous tissues; simple). If it’s embedded, use 10121 (complicated). Code 10120 pays $127 on the 2007 Medicare fee schedule (unadjusted for location); 10121 pays $238. Compare these to 99213 – the code some pediatricians default to for tick removal no matter how complicated – which pays $60.
    ‘Incision’ by forceps/tweezers
    One caveat: don’t use these codes for simply grasping a tick or splinter with tweezers and removing it, unless you have to enter the subcutaneous tissue with the tweezers. These two codes comprise the incision and removal (I&R) codes, which means there must be some kind of incision.
    In a typical case seen by the pediatric office, the tick or splinter itself penetrated subcutaneous tissues. If the end is sticking out and you can easily remove it with tweezers without entering the actual hole made by the foreign body, you should bill 10120 with modifier 52 (reduced services), says Donnelle Holle, RN, a pediatric coding consultant based in Fort Wayne , Ind.
    “There’s no formal requirement that you have to use a knife when billing an I&R code,” she says.
    But if the physician had to do some “digging” with tweezers, then bill 10120 unmodified, she says. “If you have to dig into the hole itself to remove pieces of the foreign body, then simply bill 10120 and don’t modify it.”
    A coder can tell whether to bill 10120-52, 10120 or 10121 – as well as whether to bill an additional E/M – by looking for certain phrases in the documentation, says Holle. “Splinter removed with tweezers with no complications” would be 10120-52, she says. “Splinter removed with tweezers, small amount of splinter left, had to go deeper into the area to pull out” would be 10120.
    One sure-fire way to know you can bill 10120: If the doctor had to inject lidocaine or apply topical anesthetic. This means the pediatrician opened the wound.

  8. #8
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    Default

    I'm almost inclined to use the 10121 for removal of an embedded tick that could not be pulled out; however, it does prompt this question:

    The MD did a 2mm punch biopsy with xylocaine because it wouldn't come out. Since there is nothing to biopsy, I don't feel comfortable coding it 11100.

    Any feedback?
    Heidi Thompson, CPC

  9. #9

    Default Fluid-filled??

    2017 ICD-10-CM Coding Book
    Code 10120 is listed under the "10030-10180 Treatment of Fluid-filled Lesions: Skin and Subcutaneous Tissues" category. So if a patient presents with a foreign body, such as a piece of glass but there is no "fluid-filled" issues can the 10120 still be billed for the removal?

    Thank you!

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