Pediatric Coding Alert

If your removal repertoire stops at 10120 (Incision and removal of foreign body, subcutaneous tissues; simple), rope in additional deserved pay with site-specific foreign body removal (FBR) codes.

Commonly performed foreign body removal codes can add approximately $115-$216* to a claim. You might, however, question what counts as incision and removal under 10120 and not realize that other anatomic area codes exist. Test your coding expertise with these questions.

*Note: Figures based on the 2009 Medicare Physician Fee Schedule that pediatricians can use as a benchmark for payers. For values tied to specific codes, see chart below.

Question 1: A pediatrician removes an earring back from the earlobe using probing tweezers rather than a scalpel. Should she still report 10120?

Answer 1: Yes, the technique still fits the code's description. "Ascalpel isn't the only way to have a small incision," says Charles Scott,MD, FAAP, a pediatrician at Medford Pediatric andAdolescent Medicine in New Jersey.

The physician could use tweezers or another sharp instrument. Because the earring was removed from within, there had to be a "rending" of the skin in some fashion to get it out, Scott points out. "A probing tweezers also enlarges the hole to allow removal, so in essence, there was an 'incision.'

Do this: Carefully review the physician's documentation to determine whether a procedure involved the patient's skin and/or subcutaneous tissue. For instance, with a tweezer removal, look for notes indicating the physician actually put the tweezers into a hole rather than just grasping an embedded object without widening or going into the hole.

Question 2: Dylan's mom brings him in complaining that he hasn't been responding to her. The pediatrician uses an otoscope to visualize the child's ear canal, finds it blocked by a foreign object, and removes with instrumentation a corn puff from the ear. Should you stick with 10120?

Answer 2: "Codes 10120 and 10121(... complicated) are for FB removal in the subcutaneous tissues," says John F. Bishop, PA-C, CPC, president of Bishop & Associates Inc. in Tampa, Fla.

For removals from other areas, you should check if a site-specific code exists. In this case, since the removal was from the ear canal using instrumentation, you should go with 69200 (Removal foreign body from external auditory canal; without general anesthesia). Irrigation does not count for 69200, which has the same instrumentation requirements as 69210 (Removal impacted cerumen [separate procedure], 1 or both ears).

Question 3: After running on a wooden deck, Kendall keeps complaining of a bump in her foot. The pediatrician suspects a deep splinter, uses a needle to lift a flap of skin, and explores the area as much as the girl will tolerate. The doctor, however, cannot locate a piece of wood. Can you still code the foreign body removal?

Answer 3: Yes, you can still use the site-specific FBR code (28190-52, Removal of foreign body, foot; subcutaneous) for the incision without (w/o) removal. Since the procedure resulted in no removal, take one more action.

"I would still code the FBR code appropriate for the anatomic area and apply modifier 52 (Reduced services)," Bishop says. Modifier 52 indicates the physician was not able to perform part of the CPT code's description: "removal of foreign body."

Question 4: How is removing a marble from a child's nose coded?

Answer 4: You would use intranasal foreign body removal code 30300 (Removal foreign body, intranasal; office type procedure). This code alone could pay you almost $200.