ED Coding and Reimbursement Alert

Question: When should 28190* (removal of foreign body, foot; subcutaneous) be used versus 10120* (incision and removal of foreign body, subcutaneous tissues; simple)? For example, an ED physician states that a wound was numbed and gently explored (no incision, no widening of the wound, just opening it up slightly with his fingers and the forceps) in order to grab and pull out a 1-cm splinter.

Massachusetts Subscriber

Answer: The difference between these codes is that 28190 specifically identifies the foot in the definition, while the more generic 10120 does not list a specific body site. However, 10120 does include the word incision in the definition.

Do not use 10120 for the procedure presented because, as you mentioned, the physician did not make an incision. The definition for 28190 best describes your situation. However, there are lingering questions about when to use 10120 and 28190. Code 28190 is obviously anatomically specific. However, some experts believe 28190 may be intended for operative procedures.

The RVUs attributed to 28190 support this argument. Code 10120 has 2.43 RVUs while code 28190 has 4.90 RVUs. So, contrary to common sense, the code with more RVUs does not seem to require an incision. It is unlikely CPT intended to assign 4.90 to the simple procedure of pulling out a foreign body or splinter, but the language of the definition supports 28190 in this situation.