Orthopedic Coding Alert

Question: Notes indicate that a new patient with an injured foot had a foreign body (FB) removed from her heel. The provider decided to perform foreign body removal (FBR) after a level-two evaluation and management (E/M) service. I was going to report 10121, but a colleague says no. How should I code this service?

Alaska Subscriber

Answer: Though 10121 is an FBR code, it isn’t the right one for this service. If you’re tethered to 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) and 10121 (… complicated) for all your FBR claims, expect more denials to head your way.

Why? There are far more FBR codes than just this duo—including a set for foot FBRs. Go back and check the notes, and then choose one of the more specific codes from this list:

• 28190 — Removal of foreign body, foot; subcutaneous
• 28192 — … deep
• 28193 — … complicated.

Then, report the appropriate FBR code along with 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components:

An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making … ) for the E/M.

Modifier alert: You’ll need a modifier for 99202 to show that the E/M led to the FBR removal. The modifier you choose will depend on the foot FBR you go for. If it is a 28190 claim, append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99202, as the global period for the service is minor (10 days).

If, however, you choose to code 28192 or 28193, you’ll append modifier 57 (Decision for surgery) to the E/M, as the global periods for these services is major (90 days).