ED Coding and Reimbursement Alert

Question: An ED physician removed a piece of popcorn kernel from a patient’s tonsils. What are the best CPT^®/ICD-10 codes to use in this encounter?

Maine Subscriber

Answer: In this situation, 42809 (Removal of foreign body from pharynx) is the correct code to report for the removal of the foreign body (FB). An item will typically meet the criteria for an FB if it’s not native to the respective anatomic site.

If documentation supports billing separately, you can also code an E/M visit from the 99281-99285 (Emergency department visit for the evaluation and management of a patient…) series, attaching 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) to the E/M code.

For the diagnosis, you will have to use one, or maybe two, ICD-10 codes to describe the patient’s condition. Assuming your provider did not document that the patient was asphyxiating, the first code you would use would be T17.228A (Food in pharynx causing other injury, initial encounter). Next, as this is an initial encounter, and depending on payer or state guidelines, you may want — or may have — to add a code to indicate the place of occurrence. You will find the appropriate code located in the Y92.- (Place of occurrence of the external cause …) codes.