EM Coding Alert

Question: A mother brings her child into the office complaining that the child’s breath is bad. Our physician examines the pharynx to find a stuck fish bone. The physician removes the bone with tongs. How do I code this?

Massachusetts Subscriber

Answer: If documentation supports billing separately, you will code the E/M visit from the 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...) range and report 42809 (Removal of foreign body from pharynx) for the foreign body removal (FBR).

Your provider would need to document the decision for the office level selected and a full description of the FBR for you to be able to code both services.

Attach 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. Appending the modifier will tell the payer that that the E/M resulted in performing the FBR.

Tip: You should have a separate diagnosis when appropriate to demonstrate to your payer that the E/M is above-and-beyond the minor E/M that is normally included in a FBR code. For this case, you would report halitosis (784.99, Other symptoms involving head and neck) along with the office visit code, and 933.0 (Foreign body in pharynx) with 42809.