General Surgery Coding Alert

Although any object or substance that is not part of the human anatomy can be considered a foreign body, this does not mean that foreign-body removal (FBR) codes may be used whenever such an object is extracted.

FBR codes appearing in the Surgery/Digestive System section (40000 series) of CPT are categorized according to anatomic site. The list covers endoscopic FBR from the intestine, stomach, colon, rectum and other sites. Removals of extraluminal foreign bodies, however, are more complicated. The foreign body may be embedded at varying depths (through the skin, subcutaneous tissue, fascia, muscle and bone), each of which may trigger use of a code found elsewhere in CPT. Surgeons can report FBR using codes in the Musculoskeletal section (20000 series) of CPT even if the embedded body is in the subcutaneous tissue (otherwise considered part of the integumentary system). Furthermore, the inadvertent discovery of a foreign body during an exploration may require a different code than a known foreign body that is purposefully removed. Determine FBR Code Appropriateness To determine whether an FBR code is appropriate and which one to use, you should review the operative report for answers to four questions:

1. Did the surgeon have to make an incision to remove the object? 2. Was the surgery performed to remove the foreign body, or did the surgeon discover it while doing something else? 3. Where was the object? 4. How deep was the foreign body embedded? If the foreign body is removed without an incision, an FBR code should not be billed, says Pamela Biffle, CPC, CCS-P, coding director with Concentra, a large occupational healthcare group in Addison, Texas. "For example, if the surgeon uses a pair of tweezers to remove a splinter, an FBR code should not be reported," she says. Note: The removal of a splinter is part of whichever E/M service the surgeon provided and documented. These codes should also not be used if the surgeon discovered the foreign body while performing a wound exploration, Biffle says. In these cases, you should use wound-exploration codes 20100, 20101, 20102 or 20103. For example, a patient may require that a percutaneous endoscopic gastrotomy (PEG) tube be removed. Although the PEG tube is a foreign object, the procedure should not be coded as FBR.

If a piece of the PEG tube breaks off and must be extracted, however, upper gastrointestinal endoscopy code 43247 may be billed. Note: CPT does not include a code for the removal of a PEG tube, so only the appropriate-level E/M service code can be reported. Identify Location and Depth Once it is determined that an FBR code is appropriate, the location and depth of the wound must be determined. The Musculoskeletal section [...]