Pediatric Coding Alert

These codes can net you $200+, and you probably already do these procedures

One major way to boost your revenue without offering new procedures is to optimally code the ones you are already performing by using procedural codes, not E/M service codes. A hidden gem that you may not be capitalizing on is foreign-body removal for splinter removal, bead removal and dirt removal.

The tricky part about using codes for foreign-body (FB) removal is that no single code describes the procedure. You instead have to use the anatomically appropriate code. Consider adding these five to your superbill.

Note: Dollar amounts referred to throughout this article are based on amounts listed in the 2006 National Physician Fee Schedule .

Count Removal From Soft Tissues as 10120

Question: “If a patient comes in for a splinter removal and the physician uses a needle to lift the skin flap up and uses forceps to pull the splinter out, can the pediatrician use 10120?” asks Penelope A. Ritchie, RHIT, quality improvement analyst at Mercy Medical Group in St. Louis.

Code #1: Yes. Your physicians are correct to use 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) in this case.

There is some confusion over what the incision in 10120 requires. “But splinter removal necessitating opening of the skin with a needle is appropriate use of 10120,” says Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio. The 2006 National Physician Fee Schedule Relative Value File assigns the code 3.52 nonfacility (NF) total relative value units (RVUs), which equates to $133.40 using the 2006 conversion factor of 37.8975.

Be careful: The removal must be from a soft tissue, such as a hand, and not from the foot. “The foot is not considered to be soft tissue,” says Linda Martien, CPC, CPC-H, coding specialist for National Healing Inc. in Boca Raton, Fla.

Use 28190 When You Remove Splinter From Foot
 
You probably removed a few splinters from patients’ feet this summer. But if you used an E/M code for these removals, you missed out on more than $160.

Code #2: You can report these removals with FB removal code 28190 (Removal of foreign body, foot; subcutaneous), says Richard Lander, MD, FAAP, with Essex-Morris Pediatric Group in Livingston, N.J. Doing so will net you more than $211 (5.58 total NF RVUs), compared to $38-$52 for coding an in-office removal with 99212 (1.02) or 99213 (1.39).

Get $200+ for Intranasal Bead Removal With 30300
 
See if you’re maximizing reimbursement for this FB removal: “Little Suzy comes in with a bead up her nose that the mother says she can’t get out,” Lander says.

Code #3: For taking the bead out of the child’s nose, use 30300 (Removal foreign body, intranasal; office type procedure), Lander says. A simple in-office intranasal FB removal, such as one involving tweezers, qualifies as 30300, which generally pays more than $218 (5.76 NF RVUs).

Tip: “You’re probably not going to also code an E/M service in this instance,” Lander says, because the mother already came in identifying the problem.

Code #4: If the child had instead stuck the bead in her ear and you removed the FB, use 69200 (Removal foreign body from external auditory canal; without general anesthesia). You can expect about $122 (3.22 NF RVUs) for 69200.

Report Speck Removal With 65205

Code #5: One more FB removal code Lander says you may occasionally use is 65205 (Removal of foreign body, external eye; conjunctival superficial). For the removal of a superficial foreign body (think dirt, wax, leaf bit) in the conjunctiva, you would report 65205, which contains 1.38 NF RVUs ($52.30).

Note: The physician may use a cotton swab, needle, burr or other instrument, but this does not affect the code choice.

Adapt These Practices’ FB Removal Listing Methods
 
Consider two options for adding FB removal codes to your superbill:

The pediatricians at PrimeCare of Southeastern Ohio Inc. decided not to crowd their charge sheet with individual listings of FB removal codes. They instead list “FB Removal” under “Other Procedures” and leave a blank for the physician to indicate the location of the FB. Then it’s up to the pediatrician or the coder to look up the appropriate anatomical code.

Another practice’s encounter form breaks out the five FB removal codes as follows:

• removal FB simple 10120

• removal FB ear 69200

• removal FB eye 65205

• removal FB foot 28190

• removal FB nose 30300.