ED Coding and Reimbursement Alert

Question: A patient reports to the ED with a bruised foot that is slightly bloody in the middle bottom area. The physician performs problem focused history and examination, and finds no evidence of trauma beyond the foreign body. After making an incision with a scalpel, the physician uses tweezers to remove a shard of glass from the patient's foot and irrigates the wound using saline solution. How should I code this encounter?

Answer: You can report a foot FBR code for this scenario. On the claim, report the following:

• 28190 (Removal of foreign body, foot; subcutaneous) for the foot FBR
• the appropriate-level ED E/M code (99281-99285) to represent the E/M service
• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to the E/M code to represent the E/M service.

Coding for foot foreign body removals (FBRs) can be a bit tricky, but since your physician made an incision during the removal, you can code for a foot FBR.

Possible exception: When your physician did not make an incision during removal of an FB from the foot, you might run into red tape when coding for an FBR without an incision even though the foot FBR code does not call for incision.

Many coders feel that even though the CPT descriptor excludes "incision," you should not report unless the provider makes an incision.

If you are considering coding 28190 when no incision occurs, contact your payer first to see if it finds this coding acceptable.