General Surgery Coding Alert

FBR doesn't always mean a 20000-series code CPT does not employ a uniform set of guidelines for reporting removal of foreign bodies. As such, coding for foreign-body removal (FBR) can vary greatly depending on the type of foreign body, its anatomic location, and the depth from which the surgeon must remove it.
 
Compare your toughest FBR claim to one of our four case studies, and you're sure to find the coding solution you need. Case #1: No Incision Means No Separate FBR The situation: While operating a metal lathe, the patient embeds several small metal filings in his shoulder. In the office, the surgeon inspects the wounds and, using tweezers, extracts the shards.
 
The solution: Because the surgeon did not create a separate incision to remove the foreign bodies, you cannot code an FBR, says Tara L. Conklin, CPC, an instructor for CRN Institute, a coding and reimbursement institution offering courses in reimbursement, medical billing, outpatient coding certification, and inpatient coding certification. Rather, you should include the removal of the metal filings as a component of whatever E/M service the surgeon documents (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient ...).
 
The "what if?" scenario: The patient received deep wounds when he was hit from flying debris from an exploding propane tank. The surgeon explores the open wounds, removes several pieces of debris, and debrides and closes the wounds.
 
In this case, the surgeon performed wound exploration (20100-20103) with removal of the foreign body, which you should report using the wound exploration code that best describes the anatomic location of the wound the surgeon explored (such as 20101, Exploration of penetrating wound [separate procedure]; chest). Removal of foreign bodies is included in wound exploration codes. Case #2: For Musculoskeletal FBR, Code by Location and Depth The situation: The patient in case study #1 removes the metal filings himself. After several weeks, his wounds heal, but one metal filing remains and has now become imbedded beneath the skin and into muscle. The surgeon sees the patient and, through an incision, removes the foreign body from the patient's shoulder.
 
The solution: When reporting FBR from a musculoskeletal site (muscle or even bone), you must select the correct FBR code by anatomic location and depth, Conklin says.
 
The musculoskeletal portion of CPT (20000-29999) includes specific FBR codes for the shoulder, humerus (upper arm) and elbow, hip, femur (thigh region) and knee joint, and feet and toes. CPT further defines these codes according to depth (such as subcutaneous, deep or, in some cases, complicated).
 
For example, for FBR in the shoulder, you must select among codes 23330 (Removal of foreign body, shoulder; subcutaneous), 23331 (...deep [e.g., Neer [...]