ED Coding and Reimbursement Alert

Question: Encounter notes indicate that the provider performed superficial foreign body removals (FBRs) from each foot. Here’s the catch: the FBR of the left foot included an incision, while the FBR of the right foot was performed only with tweezers and irrigation. How should I report this encounter?

Arkansas Subscriber

Answer: Since there was no incision for the FBR from the right foot, you can’t choose a procedure code for the surgery. Even though the descriptor doesn’t mention it, an incision is necessary in order to code a procedural FBR.

Do this: Roll the work for the FBR of the right foot into the overall ED evaluation and management (E/M) service, and choose a code based on that data.

On the claim, report:

• 28190 (Removal of foreign body, foot; subcutaneous) for the FBR of the left foot
• S90.852A (Superficial foreign body, left foot, initial encounter) appended to 28190 to represent the patient’s injury
• Modifier LT (Left side) appended to 28190 to indicate laterality
• The appropriate code from the 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/ or examination and high level of medical decision making) code set for the FBR of the right foot and any other E/M services separate from 28190
• 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) appended to the ED E/M code to indicate that a significant, separate E/M occurred along with the FBR of the left foot
• S90.851A (Superficial foreign body, right foot, initial encounter) appended to the ED E/M code to represent the patient’s FBR