Primary Care Coding Alert

Question: A 43-year-old established patient meets the FP at the hospital with an injured foot; he had been repairing a shed in his bare feet, and stepped on a carpentry nail with his left foot. The FP removes the subcutaneous foreign body from the patients left heel, but she does not make an incision. Is this considered a foreign body removal (FBR)?

Florida Subscriber

Answer: It depends on who you ask. According to Cheryl Starner, CPC, revenue integrity analyst for Missouris Truman Medical Centers, you can report 28190 (Removal of foreign body, foot; subcutaneous).

Reasoning: The 28190 code makes no mention of an incision. This code descriptor differs from CPT definitions for soft-tissue FBRs (10120-10121, Incision and removal of foreign body, subcutaneous tissues &), which specifically mention incision.

There are also coders, however, who feel FBRs without incisions are not FBRs at all, but E/M services.

Reasoning: Even though the foot FBR codes dont mention incision, if no incision is made, CPT considers it a non-invasive procedure, and [the service] will not warrant any additional coding besides the E/M, according to Pamela Cline, RHIT, senior coding supervisor for Medical Account Services in Frederick, Md.

While the CPT book does not mention incision for foot FBRs, the Coders Desk Reference for Procedural Coding has incision in the description. Further, some versions of 3M systems contain definitions that also call for incision on foot FBRs. If you endorse this reasoning, you should report the appropriate E/M code for the encounter at the hospital. For example, if the patient meets the FP in the emergency department (ED), you would use a code from the 99281-99285 series (Emergency department visit for the evaluation and management ...).

Best bet: If coders disagree on the incision issue, you can be sure payers will, too. Check your carriers policy before coding these services.