ED Coding and Reimbursement Alert

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.

The selected code in the example, 31575, describes a laryngoscopy, but one using a flexible fiberoptic laryngoscope. The physician in the example used a traditional metal (that is, inflexible) laryngoscope, so the 31575-31578 range does not apply.

Code 31530 reflects the equipment the physician used, but doctors generally perform this procedure in the operating room because it requires sedation to overcome the patient's gag reflex. Your procedure doesn't meet this criterion, so you should append it with modifier -52.

Be prepared: Payers may not accept this approach.