Orthopedic Coding Alert

Question: A patient reported to the orthopedist for treatment of a closed forearm fracture suffered after a fall in the street. In addition to the fracture treatment, notes indicate gravel and some small glass shards also embedded into the subcutaneous tissue of the forearm. The orthopedist removes each one, spending almost 40 minutes making sure all the foreign bodies (FBs) have been removed. Can I code this service separately from the fracture care?

Washington, DC Subscriber

Answer: As long as you can prove that this was a separate service from the closed forearm fracture fix, you would report 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) or 10121 (Incision and removal of foreign body, subcutaneous tissues; complicated) for the foreign body removal (FBR).

When choosing between 10120 and 10121, you’ll need help from the encounter notes. While CPT^® does not offer a definition of “complicated,” such factors as infection, scarring in the area, multiple FBs, or delayed treatment may complicate the FBR removal. When that happens, you should leave the determination of the procedure’s complexity to your orthopedist, but you should make sure that your orthopedist has used the term “complicated” in the documentation.

Remember: Fracture care codes have built-in services such as wound cleaning and prep, so you need to be sure there is a separate FBR present in the notes before reporting 10120 or 10121. Also, you’ll need to append modifier 51 (Multiple procedures) to 10120 or 10121 to show that it was a separate service from the fracture care — if the payer requires it.