Primary Care Coding Alert

Gain $54-225+ when you identify these items.

Automatically accepting an E/M code or rejecting an E/M-25 or emergency add-on opportunity may cost you $54-161 in non-eye foreign-body removal (FBR) and $64+ in FBR-related payment. Safely boost your pay using this action plan.

Step 1: Spot Anatomic Code

If your FP circles 99201-99215 when she removes a foreign body, let her know there's a higher-paying way. Stick with skin FBR code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) (3.41 relative

value units [RVUs]) when the FP removes an object using a simple incision.

Beware: Throughout the CPT manual, you can also find several codes for foreign-body removal from specific sites. If a provider removes an FB from one of these places, opt for the site-specific FBR code, such as:

These minor procedural codes pay $54-$161 more nationally than 99213 (Office or other outpatient visit for the evaluation and management of an established patient -) (1.68 RVUs, $64), using the 2008 Medicare Physician

Fee Schedule.

Example: To remove a piece of glass from a patient's finger, an FP uses a scalpel to cut into the subcutaneous tissues of a patient's finger. Using 10120 instead of 99213 will net approximately $66 more in pay.

Speed tip: You can find anatomic FBR codes in the CPT index under "Foreign Body Removal" and "Removal, Foreign Body". If these headings don't list the affected area, look under the anatomic area and then "removal." For instance,

to find the removal code for foot, you have to look up "Foot," and then go down to "Removal: Foreign Body" to locate the foot FBR code (28190).

Step 2: Add on E/M-25 for Above and Beyond

Don't forget to add on an office visit, when appropriate. "You would report an E/M in addition to FBR if the E/M was over and above the FBR," says Penny Osmon, CHC, CPC, CPC-I, PCS, coding and reimbursement educator for

the Wisconsin Medical Society in Madison. Reporting E/M-25 indicates either the physician evaluated and managed the patient for another problem or condition, or the examination and management resulted in a separate decision to

perform the FBR.

Example: A mother complains that her child has bad breath. An examination of the pharynx reveals a stuck fish bone. The physician uses tongs to remove the bone. You should report 42809, which will pay approximately $99 more

than 99213. Because the physician had to provide an E/M service prior to finding and then removing the foreign body, you should report an office visit appended with modifier 25 in addition to the FBR code.

"If the reason for the visit was focused solely on removing the foreign body, no E/M would be appropriate," Osmon cautions. The FBR's RVUs include the pre-work.

Before you assume that payers will include the E/M-25 in the FBR, follow these best practices:

1. Using separate diagnoses, where appropriate, will help show the payer that the E/M is above and beyond the minor E/M included in the FBR code. For instance in the halitosis, pharynx FBR scenario, linking halitosis (784.99) to the

E/M and the pharynx foreign body (933.0) to 42809 will help show that the E/M resulted in a separate decision to perform the FBR.

To meet CPT's modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of a procedure or other service) criteria and to properly appeal an E/M-25 denial,

documentation should include an E/M note that reflects the office visit level selected and a procedural note that describes the removal.

Step 3: Consider 99054 for Interrupted Schedule

For emergency situations, in which you have coded an E/M-25, you might want to also add on 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic

service).

Be careful: A walk-in who the triage nurse works into the schedule does not qualify for 99058. Instead, the condition must require the physician to interrupt his schedule to immediately treat the patient.

For instance, a mother brings in her daughter who is having trouble breathing because of apparent airway interference, offers Kent J. Moore, manager of the Health Care Financing and Delivery Systems for the American Academy of

Family Physicians in Leawood, Kan. Because the airway is potentially compromised, the FP leaves a visit with another patient and sees the child immediately. A quick exam reveals a foreign body stuck in the child's pharynx, which the

FP proceeds to remove.

"In this scenario, because the service disrupted other scheduled office services on an emergency basis, it would be appropriate to code 99058 in addition to the FBR (42809) and E/M-25," Moore says