Dermatology Coding Alert

Question: How should I submit the following claim: A patient with a tick embedded in his shoulder came to our office. The doctor removed the whole tick and it was still alive. He sent the tick to a laboratory for testing and requested blood work for the patient. Should I code this as a removal or a biopsy, and what diagnoses should I report?

New Jersey Subscriber

Answer: You should not consider the removal of the tick as a biopsy because the doctor did not remove any tissue for examination. You should code the removal using either 23330 (Removal of foreign body, shoulder; subcutaneous) or 10120 (Incision and removal of foreign body, subcutaneous tissue; simple). Your choice of which code to use should depend on whether the doctor removed the tick via an incision. The appropriate diagnosis codes you should report include 912.4 (Superficial injury of shoulder and upper arm; insect bite, nonvenomous, without mention of infection), 912.6 (Superficial injury of shoulder and upper arm; superficial foreign body without major open wound and without mention of infection) and E906.4 (Other injury caused by animals; bite of nonvenomous arthropod).