ED Coding and Reimbursement Alert

Question: We saw a patient who presented with a metal splinter in her hand. The ED physician removed the splinter, which was embedded in surface tissue. Which code applies here?

Oregon Subscriber

Answer: This foreign body removal (FBR) appears to have been subcutaneous and didn’t go all the way down to the fascia level, so you’ll report 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (… complicated), depending on encounter specifics.

A foreign body to the subcutaneous tissue might include such items as a thorn, a splinter, or even a piece of metal, as in your situation. In cases when the foreign body is deeper or involves the fascia, this should be coded using the musculoskeletal system section of CPT^®. Failure to code deeper FBRs with codes other than 10120 and 10121 will result in a serious loss of money.

There are rules for coding 10120 and 10121 that mean your provider has to go beyond pulling a splinter out of a patient’s finger to qualify as an FBR. If there is no evidence that the provider made an incision during the procedure, you cannot report 10120 or 10121. In cases when the ED physician simply pulls the foreign body out using forceps, then you should include the service in the ED code for that day.