Test Yourself: Remove Errors From Foreign-Body Claims

Dislodge confusion with two common coding solutions

Reporting foreign-body removal can be a royal pain in the neck, but you can excise any obstacles with these real-life coding solutions.
Example #1: A patient presents in the emergency department (ED) with a needle embedded in the ankle. The ED physician uses a C-arm (a portable fluoroscopy unit) to help localize the foreign body. She then makes an incision and locates the foreign body using surgical needles pressed in two planes. She grasps the foreign body, removes it, irrigates the wound, and applies a dressing. Which foreign-body removal code would you report for this procedure?
Answer #1: Your best bet in this scenario is code 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated), says Mike Granovsky, MD, CPC, chief financial officer of Greater Washington Emergency Physicians in Fort Washington, Md. You may be tempted to apply 28190* (Removal of foreign body, foot; subcutaneous), 28192 (... deep), or 20103 (Exploration of penetrating wound [separate procedure]; extremity), but the first two codes are for the foot - not the ankle - and the last one isn't as specific as 10121, Granovsky says.
In addition, while the surgical needles were near the ankle joint, you shouldn't report 27648 (Injection procedure for ankle arthrography), because the doctor did not use them to perform an injection.
If the documentation does support using a foot code, though, make sure you don't undervalue your work by reporting 28190, Granovsky says. The procedure required more work than a subcutaneous service. If you don't have enough documentation to show the use of the fluoroscopy for needle location, bundle the extra work involving the C-arm into the removal service and designate the entire service as complicated (28193, Removal of foreign body, foot; complicated). But if the documentation sufficiently shows that you used fluoroscopy for needle localization, you should consider 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034) with 28192.
Example #2: The ED physician removes a foreign body with a laryngoscope blade and Magill forceps. In this scenario, you charge for 31575 (Laryngoscopy, flexible fiberoptic; diagnostic), but you're worried because you know this code usually pertains to a bronchoscope. Should you report 31575 anyway, even though the apparatuses were different from what the code stipulates?
Answer #2: Actually, you're stuck between a rock and a hard place here. No code specifically describes the procedure, but your best shot is to use 31530 (Laryngoscopy, direct, operative, with foreign body removal) and append modifier -52 (Reduced services), Granovsky says.
The selected code in the example, 31575, describes a laryngoscopy, but one using a flexible fiberoptic laryngoscope. However, [...]

- Published on 2003-09-11