ED Coding and Reimbursement Alert

Answer: The choice of a CPT^® code in this scenario really boils down to the method your provider used to remove the splinter and the complexity of the removal itself. Since you didn’t note what happened after the patient presented to the ED, you’ll have to scrutinize the notes to find out the details.

If your provider was able to remove the splinter simply by using a pair of tweezers, and nothing more complicated occurred during the service, you would probably just use an evaluation and management (E/M) service code to document what was done (99281-99285).

However, if your provider documented that the foreign body (FB) removal was simple, but that the removal required an incision to be made in the patient’s foot, then the next most obvious choice to document the service would be 10120 (Incision and removal of foreign body, subcutaneous tissues; simple). A more complex removal, involving exploration or debridement of the wound, would be coded with 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated).

A third way to code this, again depending on the depth of the splinter and the complexity of the procedure, would be to go with a site-specific surgery code.

In this case, you could use 28190 (Removal of foreign body, foot; subcutaneous). This code indicates, again, that the removal occurred at the deeper, subcutaneous level. Anything deeper than that, for example a splinter that went down to the fascia or bone, would be recorded with 28192 (... deep). And anything that required more than just removal of the FB would also require a different code, such as 28193 (... complicated).

The main difference between the code sets 10120-10121 and 28190-28193 lies in the anatomic location based on the bedside provider’s perspective. As 28190-28193 are surgery codes, they generally require more work, and might include local anesthesia, irrigation, and even wound closure with strips or sutures when appropriate, though the code descriptor for 28190-28193 does not specify an incision.

Additionally. there is a significant difference in the payment for these two code sets.

Codes 10120, 10121, and 28190 have 10-day global periods and have total facility RVUs of 3.04, 5.41, and 3.89, respectively.

However, codes 28192 and 28193 have 90-day global periods and have assigned total facility RVUs of 9.12 and 10.75 (respectively) because of the extra work required as mentioned above.

Regardless, as the work involved in either 10120-10121 and 28190-28193 indicates that your physician performed an additional service beyond the E/M for the patient, you can also report the E/M by using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service).