Otolaryngology Coding Alert

Question: I could use help working on a foreign body removal (FBR) operative report. The surgeon made a 2 cm incision into the lingual frenulum. Dissection was then made through the floor of the mouth, down to the foreign body, which was a 3 mm displaced titanium screw. Does this qualify as 40805 or should I report an unlisted code?

South Carolina Subscriber

Answer: The surgeon’s incision into the lingual frenum and subsequent retrieval of a foreign body in the floor of the mouth disqualifies 40805 (Removal of embedded foreign body, vestibule of mouth; complicated) as a viable option. That’s because the vestibule of the mouth is entirely separate from that of the internal oral cavity.

According to Dorland’s Illustrated Medical Dictionary, the vestibule of the mouth is “the portion of the oral cavity bounded on one side by the teeth and gingivae, or the residual alveolar ridges, and on the other side by the lips (labial vestibule) and cheeks (buccal vestibule); called also external oral cavity.”

However, you shouldn’t resort to submitting this claim using an unlisted code just yet. Within the Surgical Procedures on the Musculoskeletal System chapter in the CPT^® manual, you’ll find code 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)). Contrary to some popular belief, this code may be reported on various different anatomic sites — including the oral cavity. Since the surgeon is removing a buried screw, just as the code description entails, you may consider this a “deep” removal.