ED Coding and Reimbursement Alert

Question: A patient with a splinter reported to the ED. After a level-two E/M, the physician uses a needle to make an incision and remove the splinter from the patient's right foot. The insurer rejected 10120 as mismatching the diagnosis. Should I appeal the denial?

North Dakota Subscriber

Answer: The problem may have been a mismatch between the CPT® procedure code and the ICD-9 diagnoses code on the claim. Before sending in a claim for foreign body removal (FBR), make sure you have assigned the most specific code for the anatomical area treated. CPT® contains a specific code for a foreign body removal from the foot. You should have reported 28190 (Removal of foreign body, foot; subcutaneous) for the FBR rather than 10120 (Incision and removal of foreign body, subcutaneous tissues; simple). You should be able to refile the claim with the correct code.