Remove Foreign-Body Billing Woes With Coding Examples
Published on Tue Apr 01, 2003
Reporting foreign-body removal (FBR) services can be a royal pain in the neck for ED coders. Dislodge FBR coding obstacles by using these real-life ED situations to hone your coding skills. Example #1, Ankle FBRs: A patient presents with a needle embedded in the ankle. The ED physician uses a C-arm (portable fluoroscopy unit) to help localize the foreign body. The physician then makes an incision and locates the foreign body using needles placed in two planes. He grasps the foreign body, removes it and then irrigates the wound and applies the dressing.
Answer: The best fit for this scenario is 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated), Martin Herman, MD, FAAP, FACEP, associate professor of pediatrics at UT College of Medicine, West Tennessee, Tenn., states after conferring with Mike Granovsky, MD, CPC. Some coders might be tempted to report 28190* (Removal of foreign body, foot; subcutaneous), 28192 ( deep) or 20103 (Exploration of penetrating wound [separate procedure]; extremity). But the physician performed the procedure on the ankle, and 28190 and 28192 are for the foot, Granovsky warns. In addition, although the needle was near the ankle joint, you shouldn't report the one code under introduction/removal for the ankle, CPT 27648 (Injection procedure for ankle arthrography), since you're not performing an injection. But if the doctor's documentation shows that the primary location of the foreign body was the foot, 28190 would undervalue the work, Granovsky states. If you don't have enough documentation to show the use of fluoroscopy for needle location, you could bundle the extra work involving the C-arm into the removal service and designate the entire service as complicated (28193, Removal of foreign body, foot; complicated). If the documentation sufficiently shows that the physician used fluoroscopy for needle localization, you could consider 28192 along with 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]). The ED physician may report and expect payment for 76000 for the fluoroscopy when the radiologist is not present, but the physician must write a radiology report indicating what he saw when he used the fluoroscopy, says Michael Ferragamo, MD, a coding expert who practices with Ferragamo, Bruno, Efros, a group practice in Garden City, N.Y.
The physician should also note in the operative report: "under fluoroscopic control to localize the foreign body." Use modifier -26 (Professional component) because you're billing for the reading of the film, not the use of the hospital's machine. Example #2, Laryngoscopies and FBRs: The ED physician removes a foreign body with a laryngoscope blade and Magill forceps. In this case, the coder charges out 31575 (Laryngoscopy, flexible fiberoptic; diagnostic), but worries because this code pertains [...]
