When Is Foreign Body Removal Not Foreign Body Removal? The Answer You Need Is Here
Published on Tue Sep 26, 2006
Location and depth are crucial--but not enough--to guide your code selection
If the surgeon removes any object not part of the human anatomy, he technically performs a foreign body removal (FBR). Unfortunately, this straightforward logic doesn't carry over into coding principles.
To be sure you-re reporting FBR procedures appropriately, you-ll have to answer four questions. 1. Was an Incision Required? If the surgeon can remove the foreign body without making an incision (or using a scope), you won't report an FBR, says Linda Martien, CPC, CPC-H, coding specialist with National Healing in Boca Raton, Fla. In such cases, you-ll likely be able to report only an E/M service at the level best supported by the physician's documentation of the patient encounter.
Example 1: The surgeon uses tweezers to remove a splinter from an elderly patient's left forefinger, applies antibiotics and dresses the wound.
Because the physician need not make a separate incision in this case, you cannot report an FBR code (although the surgeon did--in the strictest sense--remove a foreign body). Instead, you will report an appropriate E/M service code (for example, 99212, Office or other outpatient visit for the evaluation and management of an established patient ...).
Example 2: The patient arrives for a follow-up office visit for the purpose of removing a percutaneous endoscopic gastrotomy (PEG) tube. The surgeon removes the tube without complication.
Here again--although the PEG tube is a foreign object--you should not report an FBR code. The surgeon did not have to perform an -invasive- procedure, either via an incision or by using a scope, to remove the PEG tube. Therefore, you can only report an E/M code for the service.
Alternative scenario: Suppose, however, that a portion of the PEG tube broke off during removal, requiring the surgeon to use a scope to extract it.
In this case, because the surgeon had to use the scope, you may report FBR using upper GI endoscopy code 43247 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with removal of foreign body).
Reasoning: Although Chapter 6 of the National Correct Coding Initiative (NCCI) stipulates that -CPT code 43247 is not to be reported for routine removal of therapeutic devices previously placed,- this is not a -routine removal.-
In this case, there is no way to remove the portion of PEG tube manually. Your documentation should make clear, however, the necessity for using the scope to retrieve the portion of the broken tube. Without documentation, the payer will likely reject the claim. 2. Was the FBR -Incidental-? You should also not report FBR if the surgeon discovers and removes a foreign body during wound exploration, Martien says. In such cases, the FBR is incidental to the exploration, and you [...]
