ICD 10 Coding Alert

Plus, find some expert tips on coding FBR encounters.

Foreign body removal (FBR) encounter can be common encounters for physicians who see pediatric patients — and the coders who report those encounters.

Delve into the 2024 ICD-10-CM updates so you’re prepared to code FBR encounters with the 173 new W44 (Foreign body entering into or through a natural orifice) codes before they go into effect Oct. 1, 2023.

Revisit W Codes

The new ICD-10-CM W codes are going to make it a lot easier to code a common pediatric encounter.

“Often, when patients’ little fingers got a hold of something they should not have… an item ends up in a place it should not,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/ auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. “These codes will help us identify the specific object for clearer documentation.”

The codes are broken down by the material that makes up the foreign body:

Batteries: One of the more potentially dangerous materials is represented with W44.A- (Battery entering into or through a natural orifice):

• W44.A0- (Battery unspecified …)
• W44.A1- (Button battery …)
• W44.A9- (Other batteries …)

Plastic: When a patient has inserted an object made of plastic, you’ll select from the following W44.B- (Plastic entering into or through a natural orifice) codes:

• W44.B0- (Plastic object unspecified …)
• W44.B1- (Plastic bead …)
• W44.B2- (Plastic coin …)
• W44.B3- (Plastic toy and toy part …)
• W44.B4- (Plastic jewelry …)
• W44.B5- (Plastic bottle …)
• W44.B9- (Other plastic object …)

Glass: The following are for use when glass is the foreign body, reported as W44.C- (Glass entering into or through a natural orifice)

• W44.C0- (Glass unspecified …)
• W44.C1- (Sharp glass …)
• W44.C2- (Intact glass …)

Magnetic and nonmagnetic metal: ICD-10 has created codes that distinguish between magnetic W44.D- (Magnetic metal entering into or through a natural orifice) and nonmagnetic W44.E- (Non-magnetic metal entering into or through a natural orifice) metals to help you more accurately specify the material and potentially also the severity of the situation:

• W44.D0- (Magnetic metal object unspecified …)
• W44.D1- (Magnetic metal bead …)
• W44.D2- (Magnetic metal coin …)
• W44.D3- (Magnetic metal toy …)
• W44.D4- (Magnetic metal jewelry …)
• W44.D9- (Other magnetic metal objects …)
• W44.E0- (Non-magnetic metal object unspecified …)
• W44.E1- (Non-magnetic metal bead …)
• W44.E2- (Non-magnetic metal coin …)
• W44.E3- (Non-magnetic metal toy …)
• W44.E4- (Non-magnetic metal jewelry …)
• W44.E9- (Other non-magnetic metal objects …)

Natural and organic materials: The following W44.F- (Objects of natural or organic material entering into or through a natural orifice) codes cover a variety of miscellaneous natural materials:

• W44.F0- (Objects of natural or organic material unspecified …)
• W44.F1- (Bezoar …)
• W44.F2- (Rubber band …)
• W44.F3- (Food …)
• W44.F4- (Insect …)
• W44.F9- (Other object of natural or organic material …)

Non-organic materials: W44.G- (Other non-organic objects entering into or through a natural orifice) covers several non-organic objects as well as combinations of materials:

• W44.G0- (Other non-organic objects unspecified …)
• W44.G1- (Audio device …)
• W44.G2- (Combination metal and plastic toy and toy part …)
• W44.G3- (Combination metal and plastic jewelry …)
• W44.G9- (Other non-organic objects …)

Sharp objects: Report W44.H- (Other sharp object entering into or through a natural orifice) when the material is sharp (except for glass).

• W44.H0- (Other sharp object unspecified …)
• W44.H1- (Needle …)
• W44.H2- (Knife, sword or dagger …)

Other, Uspecified, and Unknown: Also, be on the lookout for an “other” and “unspecified” code in this new set. You’ll have W44.8- (Other foreign body entering into or through a natural orifice) and W44.9- (Unspecified foreign body entering into or through a natural orifice) available to choose from. Remember that “details known at the time of the encounter should drive the choice between the ‘Other’ and ‘Unknown’ code varieties that are available. ‘Other’ should be reported when there are known details for which there is no specific code descriptor. ‘Unknown’ is for use when details are not available at the time of encounter to make a specific choice,” explains Jan Blanchard, CPC, CPEDC, CPMA, pediatric solutions consultant at Physician’s Computer Company in Winooski, Vermont.

Coding alert: Each of these codes requires a 7th character representing the encounter type as follows:

• A = initial encounter
• D = subsequent encounter
• S = sequela

Report the Removal Like This

In some cases, the pediatrician will be able to remove the foreign body during one of the encounters. Before determining which code to use for that, first determine how the material was removed.

No incision: If the pediatrician does not make an incision, and instead removes the material using tweezers or another implement, it would be considered part of an evaluation and management (E/M) visit.

If the procedure is simple enough to be done safely in the office, the established patient’s complaint can be regarded as an acute, uncomplicated illness — defined by CPT® as “a recent or new short-term problem with low risk of morbidity for which treatment is considered,” and for which “there is little to no risk of mortality with treatment, and full recovery without functional impairment is expected.” Additionally, the foreign body removal (FBR) itself presents a low risk of morbidity to the patient. These two low elements of medical decision making (MDM) combine to give an overall low MDM, enabling you to easily justify billing 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.) for the visit.

Incision: In the unlikely event the FBR turns from an E/M to a removal by incision, or if your pediatrician immediately uses a scalpel or other sharp instrument to help remove the foreign body in the encounter, two procedure codes may then come into play: 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (… complicated).

Note: If the pediatrician used the term “complicated” in the documentation, you can go with 10121. If you’re ever unsure whether a FBR is simple or complicated, query the provider.