General Surgery Coding Alert

Question: A patient came to our practice with pain in his shoulder. During the visit, the patient explained that he-d had several metal shavings embedded in his shoulder from a work accident two weeks before, but he thought he had removed them all. The physician had to perform an incisional foreign body removal. The documentation states that the surgeon had to remove the metal from "below the fascia." I know I shouldn't use 10120 or 10121, but which code should I use?

Colorado Subscriber

Answer: You should turn to the musculoskeletal section of the CPT manual: 20000-29999. When reporting a foreign body removal (FBR) from a musculoskeletal site (muscle or bone), you-ll select the proper code based on the anatomic location and the depth of the incision your physician documented.

The CPT manual's musculoskeletal section 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 (subcutaneous, deep, or complicated).

How it works: For FBR in the shoulder, you must 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 general surgeon removes the foreign body from the subcutaneous tissue or anywhere else above the fascia, you would select code 23330. If the physician must go below the fascia, use should instead use 23331. In the case of a particularly complex procedure, you should select 23332. In this case, your best code selection is 23331.