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I&D without incision

  1. Default I&D without incision
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    Is it true that if there is no incision, I cannot code 10120? The patient wanted to try removing a splinter without opening the area. The physician manipulated the ares and was eventually able to express a wooden splinter, 2 cm in length. In the note, the area is described as "an entry wound approximately 3 mm across with a surrounding area of erythema, warmth and induration measuring approx. 3 cm across. Within there is a slightly palpable sense of splinter. Scant drainage is present, though nonpurulent." In addition the patient had tried unsuccessfully to extract the splinter. The area has become increasingly painful. Thanks for your opinion or feedback, in advance.

  2. #2
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    Correct, without an incision, there is no Incision and removal of a FB, subcutaneous tissues, simple 10120.

    If the splinter was located in the foot, the removal (28190) description does not involve an incision. There has been disagreement amongst coders whether an incision is required (Ingenix describes it as an incisional procedure in the Coder's Desk Reference). Payer guidance may be helpful.

  3. #3
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    Quote Originally Posted by Mojo View Post
    Correct, without an incision, there is no Incision and removal of a FB, subcutaneous tissues, simple 10120.

    If the splinter was located in the foot, the removal (28190) description does not involve an incision. There has been disagreement amongst coders whether an incision is required (Ingenix describes it as an incisional procedure in the Coder's Desk Reference). Payer guidance may be helpful.
    Coding Clinic for HCPCS 4Q 2006 said that 28190-28193 require an incision.

  4. #4
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    I believe removal of FB with manipulation technique would be inclusive in E/M code.
    Girish Dadhich, CPC

  5. Default Splinter removal
    You are correct. A splinter removal without incision has no CPT code- it is part of the E&M.

    We found this out several years ago when a patient with a high deductible got billed for the procedure.

    Boy, was he mad! bOY, WERE WE EMBARASSED WHEN WE ACTUALLY READ THE CODE.

  6. #6
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    This is from Ingenix

    28190-28193 (28190, 28192, 28193)

    Subcutaneous refers to something under the skin. An incision is made through the skin and it is reflected to expose the foreign body. It is removed and the wound is irrigated and the wound is closed. A dressing is applied and aftercare may include antibiotic injection into the wound and orally. Weight bearing is allowed as the wound heals. Report 28192 if the foreign body lies deeper in the foot. Report 28193 if repair of torn tendon, nerves, and blood supply is required.

  7. #7
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    When coding this in our system we came up with this edit Non-incisional removal of a foreign body from the skin and subcutaneous tissue is considered to be part of the E&M code and is not reported separately

  8. #8
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    Quote Originally Posted by donnajrichmond View Post
    Coding Clinic for HCPCS 4Q 2006 said that 28190-28193 require an incision.
    Yeah, I was surprised to see in The Lynx Reference Manual for ED coding that an incision is not required for 28190.

  9. Default
    For everyone's info - regarding 10120. Coding Clinic for HCPCS 3Q 2002, page 8 states that removal of foreign body without incision cannot be coded as 10120. It can only be captured by the appropriate e/m service code.
    I just found this one today
    Kim
    Kim Sullivan, MA, CPC, CEMC, CCS

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