ED Coding and Reimbursement Alert

Question: The patient presents with a hair tourniquet. I can only report a nonspecific injury code for the toes, fingers or labia, and I've included the removal procedure in the E/M service. Is there another code I should report?

New Jersey Subscriber

Answer: You can report 10120* (Incision and removal of foreign body, subcutaneous tissues; simple) for the procedure if the hair has burrowed through the skin and is, in fact, in the subcutaneous layer of the skin tissue. You do have to bundle the procedure into the E/M, however, if the hair is still on top of the skin, because there is no code for skin foreign-body removal.

If you have to include the work in the E/M service, you should note that this case qualifies as potentially moderate risk because it could involve a threatening problem for the limb or digit. The untreated tourniquet will eventually cause venous engorgement and will ultimately block arterial inflow. If the medical chart describes the early states of engorgement, you should probably qualify the case as moderate risk.

If your physician is applying a depilatory before the removal, bundle that application into the E/M service.