ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a fish hook in his left index finger. Notes indicate that the physician removed the fish hook and sent the patient home.

North Dakota Subscriber

Answer: It depends on whether or not the physician made an incision to remove the hook. Go back and check the operative notes for evidence of an incision. After you answer that question, choose one of these strategies:

Incision made: If there was an incision, you can report an FBR code. So if the notes indicate an incision, report 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) for the procedure.

No incision: If there was no incision, report the appropriate level E/M code.

Set a practice policy: The "incision decision" on FBR claims is not as cut-and-dried as it might seem. When the FB makes its own "incision," such as an embedded fish hook, some practices consider it proof of incision and use FBR codes. However, some practices don't consider this an "incision"; they only code for incisions when the physician makes one to facilitate FBR.

If it doesn't already, your ED should have a policy in place that spells out the practice definition of "incision."