ED Coding and Reimbursement Alert

Question: A patient with a splinter reports to the ED. After a level-two E/M, the physician uses a needle to make an incision and remove the splinter from the patient's right foot. The insurer rejected 10120 as mismatching the diagnosis. Should I appeal the denial?

North Dakota Subscriber

Answer: Before sending in a claim for foreign body removal (FBR), make sure you have assigned the most specific code for the anatomical area treated. For a foot FBR, CPT contains a specific code.

You should re-submit the claim with the following:

- 99282 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem focused history; an expanded problem focused examination; medical decision-making of low complexity) for the E/M

- modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to 99282 to show that the E/M is significant and separate from the FBR.

- 28190 (Removal of foreign body, foot; subcu-taneous) for the FBR.

Exception: If the physician had instead removed the splinter from the patient's hand, you would use the general FBR code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple).