# help with CPT(s)



## ggparker14 (Jul 18, 2011)

Fish hook in hand. Can anyone give me their opinion on this procedure note from ER note? 

Note reads: the hand was anesthetized with one percent plain lidocaine and the fish hook cut off at the lure and pushed forward through the palm. No problems or complications. Still good ROM.

Would this procedure be included in the E/M code?

Thanks for any help.


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## btadlock1 (Jul 18, 2011)

rhblevins61@yahoo.com said:


> Fish hook in hand. Can anyone give me their opinion on this procedure note from ER note?
> 
> Note reads: the hand was anesthetized with one percent plain lidocaine and the fish hook cut off at the lure and pushed forward through the palm. No problems or complications. Still good ROM.
> 
> ...



Ewww...it's stories like this that kept me from ever wanting to be a doctor! Just the thought of seeing that gives me the willies! 

Seems like an intermediate repair of the skin, to me (1204X). You'd need to know the length of the wound to assign the right code. Hope that helps!


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## Mojo (Jul 18, 2011)

No incision was made and I do not see a repair. The service is considered packaged with the E/M service.


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## btadlock1 (Jul 18, 2011)

Mojo said:


> No incision was made and I do not see a repair. The service is considered packaged with the E/M service.



I got that based on this under the definitions of repair "Single-layer closure of heavily contaminated wounds that have required extensive cleaning or removal of particulate matter also constitutes intermediate repair."

But now that I've looked some more, I'd almost say that 20103 would be better. "20100-20103 relate to wounds resulting from penetrating trauma. These codes describe surgical exploration and enlargement of the wound....removal of foreign bodies...etc." A fish hook seems to fall under 'foreign body' more than 'particulate matter'. 

It seems to have enough of the markers of a surgical procedure (granted, a simple one), to justify a separate surgery code, in my opinion. He had a foreign body lodged in his skin, received local anesthesia, and the doctor removed the foreign body. Ear wax removal isn't that complicated and even it has its own CPT code. 

I'm by no means saying that I think I'm right about this, but I'd like to know where my logic's flawed if I'm not, so I don't make the same mistake again in the future. Where's the line between minor ED procedures, and those eligible for separate reimbursement?


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## btadlock1 (Jul 18, 2011)

Okay - this is really bugging me now...I've read at least 5 different places that in order for a procedure to count as a 'surgery', the provider has to make an incision. Apparently it's a CPT guideline? I can't find it anywhere, or anything that even resembles it. I can understand codes that have the word 'incision' right in the description, but I must be missing something on the others...

This seems to be totally common knowledge, and I've never heard of it and can't find it. Does anybody know if/where such a guideline exists? Please point me in the right direction!


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## Mojo (Jul 18, 2011)

Hey Brandi!

The documentation does not support the wound exploration codes of surgical exploration and enlargement of the wound... in the OR. No incision of the skin was even documented. Had an incision been performed and documented with the FB removal of subq tissues, 10120 is indicated. To code10121, I look for the dissection of underlying tissues in the report.

Regarding 69210: ear wax removal does require certain documentation as well (wax must be impacted, instrumentation used, effort...).

Here is an older article that includes a fish hook removal scenario:
http://health-information.advanceweb.com/Article/Brush-Up-on-Integumentary-System-CPT-Coding-Part-1.aspx


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## btadlock1 (Jul 18, 2011)

Mojo said:


> Hey Brandi!
> 
> The documentation does not support the wound exploration codes of surgical exploration and enlargement of the wound... in the OR. No incision of the skin was even documented. Had an incision been performed and documented with the FB removal of subq tissues, 10120 is indicated. To code10121, I look for the dissection of underlying tissues in the report.
> 
> ...



I appreciate it - what about this CPT guideline regarding an incision being required to be considered an invasive procedure? (I used the word surgery before, but that was the wrong word...) Have you heard of it? Also, what are your thoughts on if the fishhook was advanced through the skin? Some opinions I read seemed to think that poking it out the other side before cutting it would consititute an 'incision', but it seemed like they were using a bit of creative interpretation to get there...

This is all very foreign to me - look up Lubbock, TX on a map and you'll understand why.


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