Pediatric Coding Alert

Question: Our pediatrician just saw a young patient who complained of a sliver in his finger after helping his father stack firewood. During the encounter, our provider made an incision in the finger and explored down into the dermis but could not find the foreign body. How should I code this— should I use 10120, or would this be considered a low-level evaluation and management (E/M) service?

Iowa Subscriber

Answer: In order to code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple), your provider should have removed the sliver per the code descriptor. As this did not happen, one way to code the encounter would be to report the code but append modifier 52 (Reduced services) to show that your pediatrician performed the incision but did not remove the sliver. If you go this route, your claim should include documentation that clearly states what your provider did and that he or she was not able to remove anything during the procedure.

However, if your payer does not recognize 10120-52, your other option, as you suggest, would be to bill a low-level E/M encounter for the service such as 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making…. Typically, 10 minutes are spent face-to-face with the patient and/or family) for a new patient or 99212 (Office or other outpatient visit for the evaluation and management of an established patient …) for a patient who is established with your practice.