General Surgery Coding Alert

Question: The surgeon removed a fishhook by inserting an 18-gauge needle into the puncture. Should I report this using a foreign-body removal code?


South Carolina Subscriber

Answer: Yes. The CPT codes for foreign-body removal that may be appropriate in this case are 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) and 10121 (... complicated), and both codes require the physician to make an incision to remove the object. The insertion of a needle this size would generally meet the requirement for making an incision.

If the physician doesn't create an incision to remove the foreign body, you should roll the work for the removal into the evaluation and management code you report.

When reporting foreign-body removal from a musculoskeletal site (muscle or even bone), you will select the correct code by anatomic location and depth. 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, if the surgeon performs a foreign-body removal in the shoulder, you'll select among codes 23330 (Removal of foreign body, shoulder; subcutaneous), 23331 (... deep [e.g., Neer hemiarthroplasty removal]) and 23332 (... complicated [e.g., total shoulder]).

If the doctor removes the foreign body from the subcutaneous tissue or anywhere else above the fascia, you would select 23330. If she must go below the fascia, use 23331. In the case of a particularly complex procedure (such as when the whole shoulder area is involved), you should select 23332.