Primary Care Coding Alert

Restricting 10120 to scalpel incisions could be costing your practice $80.

While you should never code soft-tissue foreign body removal (FBR) when the service does not warrant it, be on the lookout for potential 10120 claims -- even when the FP uses a less conventional instrument to perform the FBR -- which can net your practice approximately $120 in pay.

Be careful, though: Some FBRs are actually only E/M services. Check out these useful tips on telling them apart.

Spot Incision to Triple 99212 Pay

Incisions are what separate procedural FBRs from FBRs that occur during an E/M service, confirms Linda Martien, CPC, CPC-H, coding specialist at National Healing Inc. in Boca Raton, Fla.

Example: The FP is treating a 6-year-old established patient who has a splinter lodged under the skin in his left forearm. He uses a scalpel to make a simple incision over the FB, and pulls the splinter out with a pair of forceps.

This is a simple FBR, which you report with 10120 (Incision and removal of foreign body, subcutaneous tissues; simple), confirms Kevin Solinsky, CPC, CPC-I, CPC-ED, president and CEO of Healthcare Coding Consultants LLC in Gilbert, Ariz.

Money-maker: Youll make almost $80 more in pay for spotting 10120, rather than coding only 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making ...). Code 10120 pays approximately $120 (3.33 transitioned non-facility relative value units [RVUs] multiplied by conversion factor [CF] of 36.0666) using Medicares 2009 Physician Fee Schedule. Code 99212 pays $37 (1.03 RVUs x 36.0666 CF).

Go With E/M When No Incision

If the FP makes no incision during the FBR, then code the removal as an E/M service, explains George Ward, billing supervisor with South of Market Health Center in San Francisco.

One small switch turns the previous example from FBR to E/M service. Lets say that the FP examines the boys forearm and pulls the splinter out with forceps. Since he did not make an incision, this is an E/M service, probably 99212.

Note: This advice is strictly for coding soft-tissue FBRs. Do not apply this guidance to coding procedures such as eye and foot FBRs, which have their own reporting rules.

Extend Your Incision Definition

There may be some instances where the physician does not make a standard incision with a scalpel, but you can still code a soft-tissue FBR, explains Debra Williams, CPC, billing supervisor at Horizon Billing Specialists in Grand Rapids, Mich.

Example: Suppose a patient presents with a shard of glass wedged in the skin of his palm. The physician uses a 22-gauge needle to unroof the area and then removes the shard with surgical tweezers. In this encounter, the FP makes the incision with a needle through the unroofing process.

Some think an incision must be made with a blade, Williams says. But the physician can also make an incision with a needle or other surgical device and report soft-tissue FBR codes.

Do this: Check with your insurer if you are unsure whether an unconventional incision makes the cut for a procedural FBR.