ED Coding and Reimbursement Alert

Question: Is it appropriate to code for removal of multiple foreign bodies in a penetrating wound by reporting CPT codes from the Wound Exploration (20100 or 20103) category multiple times in the same area? Or should the codes only be reported once?

Anonymous IL Subscriber

Answer: The removal of multiple foreign bodies would be included in the exploration code, unless multiple wounds were explored and could be identified in separate anatomical sites as described by the four wound exploration codes. The August 1996 CPT Assistant and the guidelines for use of the wound exploration codes in the wound exploration section of CPT indicate Wound Exploration-Trauma (e.g., penetrating gunshot, stab wound), 20100-20103, includes surgical exploration and enlargement of the wound, extension of dissection (to determine penetration), debridement, removal of foreign body(s), ligation or coagulation of minor subcutaneous and/or muscular blood vessel(s), of the subcutaneous issue, muscle, fascia, and/or muscle, not requiring thoracotomy or laparotomy. If a repair were done to major structure(s) or major blood vessel(s) requiring thoracotomy or laparotomy, then those specific code(s) would supersede the use of codes 20100-20103. To report simple, intermediate, or complex repair of wound(s) that do not require enlargement of the wound, extension of dissection, etc., as stated above, use specific repair code(s) in the Integumentary System section.

The June and August 1996 CPT Assistant addressed these codes stating that their use requires documentation of the exploration, which would be indicated by the physicians assessment of the damage, including damage to vessels and non-major structures.

Repair of the injury to major structures would be identified with the appropriate treatment/repair code(s). In general, these exploration codes are used to indicate the physicians exploration to determine the extent of the injury through examination of layers of tissue and vessels/structures involved in the injury, and assessment of the need for suturing or repair of major vessels. Again, if the physician performed the actual repair of the major vessels or structures it would supercede use of these codes.

To fully evaluate the value of these services, a review of the Medicare RVUs for the wound exploration are as follows:

20100Exploration of penetrating wound (separate rocedure); neck 16.21

20101chest 5.16

20102abdomen/flank/back 6.31

20103extremity 8.49

An alternative for reporting treatment of less-complicated penetrating wounds that involve removal of foreign bodies but do not require significant exploration, the appropriate incision and removal code from the corresponding anatomical section of CPT should be used (e.g., foot [28190-28193]; shoulder [23330-23332]; eyelid [67938]; etc.).