ED Coding and Reimbursement Alert
Observe Foot FBR Rules From the Ankle Down
Use different codes, or your ED could be footing the FBR bill. When the ED physician performs foreign body removal (FBR) on a patient's foot, coders won't be able to rely on the soft-tissue FBR codes. What actually constitutes a foot FBR is also a matter of some controversy. Here's the scoop on the foot FBR facts all coders agree on -- and the lowdown on the ones that are still up for debate. Foot Begins Where Talus Ends -For coding purposes the foot ends at the proximal end of the talus; or just below the distal tibia/fibula,- explains Joshua Tepperberg, CPC, EMT-D, ED coding team leader at Caduceus Inc. in New York City. When the claim confirms that the physician removed an FB from below this area, choose a code from the 28190-28193 code set. What qualifies as a foot FBR, however, is a matter of speculation. Incision Necessary? Some Coders Say -No- Let's say the ED physician removes a subcutaneous FBR from a patient's left heel without making an incision. According to Cheryl Starner, CPC, revenue integrity analyst for Missouri's Truman Medical Centers, you can report 28190 (Removal of foreign body, foot; subcutaneous). Reasoning: -28190 makes no mention of an incision,- offers Sharon Richardson, RN, compliance officer with Emergency Groups- Office in Arcadia, Calif. This code descriptor differs from CPT definitions for 10120-10121 (Incision and removal of foreign body, subcutaneous tissues -), which specifically mention incision. Other Coders Say Incision Is Necessary There are also coders that feel FBRs without incisions are not FBRs at all, but E/M services. Reasoning: Even though the foot FBR codes don't mention incision, -if no incision is made, CPT considers it a non-invasive procedure, and [the service] will not warrant any additional coding besides the E/M,- according to Pamela Cline, RHIT, senior coding supervisor for Medical Account Services in Frederick, Md. While the CPT book does not mention incision for foot FBRs, the Coder's Desk Reference for Procedural Coding has incision in the description, Tepperberg offers. Further, some versions of 3M systems contain definitions that also call for incision on foot FBRs. Best bet: If coders disagree on the incision issue, you can be sure payers will, too. Check your carrier's policy before coding these services.
ED Coding and Reimbursement Alert
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