General Surgery Coding Alert

Question: Our surgeon saw a patient in the office who had several small metal filings embedded in his shoulder after a lawn-mower accident. The surgeon inspected the wounds and, using tweezers, extracted the shards. How should I report this? Can I use a foreign- body removal code?

Ohio Subscriber

Answer: Because the surgeon did not create a separate incision to remove the foreign bodies, you cannot report a foreign-body removal (FBR) code.
 
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 ...).
 
Alternative scenario: What if the patient received deep wounds when he was hit from flying debris expelled from under a running mower? In this case, the surgeon explores the open wounds, removes several pieces of debris, and debrides and closes the wounds.
 
Here, you could report 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.
 
A separate FBR code might be correct if, for instance, the patient in your question tried to remove the metal filings himself and, after several weeks, 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.
 
When reporting FBR from a musculoskeletal site (muscle or even bone), you must select the correct FBR 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: 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]), according to the depth of the exploration the surgeon must undertake to remove the foreign body.