Pediatric Coding Alert

Reviewed on April 29, 2015

Question: A pediatrician removed 15 splinters. Should I bill for each splinter removal, such as 12021 x 15 units?

New York Subscriber

Answer: Splinter removal can fall under one of two CPT procedural codes or an E/M service.

1. When a physician has to use a needle to open soft tissue to remove a splinter, use 10120 (Incision and removal of foreign body, subcutaneous tissues; simple).

2. When a pediatrician removes a splinter from the foot, use 28190 (Removal of foreign body, foot; subcutaneous).

3. If the removal does not require a needle or occur from the foot, include the work in the E/M service code (99201-99215, Office or other outpatient visit …).

You may be able to bill per removal but not with the code you mention. Codes 12020 and 12021 are for wound dehiscence, a wound that is splitting open or bursting. Wound dehiscence usually describes the opening up of a previously sutured area (for example, an incision following surgery or wound repair). If a wound becomes infected, it will more likely dehisce due to the natural inflammatory process.

Wound dehiscence code 12020 (Treatment of superficial wound dehiscence; simple closure) describes repair when there is no sign of infection. In this case, the physician simply debrides and irrigates the wound and closes it in a single layer. If infection is evident, the doctor may prefer to clean the wound and pack it with gauze strips, leaving the wound open to allow infection to drain. Code this latter procedure with, 12021 (... with packing) is the correct choice.

Bonus: All of the above procedural codes allow you to bill per removal -- or per wound dehiscence. For instance, a pediatrician uses a needle to lift the skin flap up and uses forceps to pull 5 splinters out of a child’s right hand and 10 out of her left foot. You should report 10120 x 5 and 28190 x 10.

According to the Correct Coding Initiative (CCI), code 10120 is a column two code for 28190, but you can use a modifier such as 59 (Distinct procedural service) to separate the two if your documentation supports its use.

Payers may balk at paying multiple foreign body removals. You may, therefore, need to use a modifier, such as 76 (Repeat procedure by same physician) or 51 (Multiple procedures), on the subsequent removal codes. For example, report 10120, 10120-51 x 2 for the removal of three splinters from a child’s hand. Using modifier 51 typically reduces subsequent procedure payments by 50 percent.