Radiology Coding Alert
Learn How to Identify the New Foreign Body Codes
Just don’t sequence the W44.- codes first. Among the more than 500 code changes to the 2024 ICD-10-CM code set are 173 new codes to the External Causes of Morbidity section. Effective Oct. 1, 2023, the ICD-10-CM code set’s new W44.- (Foreign body entering into or through a natural orifice) codes will make it easy to specify the object that the provider finds in the patient’s body after a radiology scan, which will lead to clearer documentation as to the purpose of the visit. Here’s how to report these new codes, so you’re ready when they take effect on Oct. 1, 2023. Build Your Foreign Body Coding Knowledge “The new W44.- codes represent more serious conditions caused by foreign bodies — for example, a swallowed button battery leaking chemicals and burning internal organs, or a swallowed sharp object lacerating internal body structures,” says Lauren E. Braico, CPC, CEDC, medical coder at Practice Resources LLC in Syracuse, New York. The W44.- codes are listed under External Causes of Morbidity in the 2024 ICD-10-CM code set because the codes focus more on the how and by what means the injury occurred, as opposed to what body area was injured. “More benign foreign body codes, such as a bead in nose or ear or food in the esophagus can be found in T15-19 (Effects of foreign body entering through natural orifice),” Braico explains. The W44.- code subcategories are broken down by the material of the foreign body. Below is a selection of the new foreign body diagnosis codes that you’ll need to know as a radiology coder. Batteries: You’ll assign a code from W44.A- (Battery entering into or through a natural orifice) if the provider finds a battery inside the patient’s body on an imaging scan. Codes in this subcategory include: Plastic: ICD-10-CM codes from W44.B- (Plastic entering into or through a natural orifice) are reserved for diagnoses when a plastic object is found inside the patient. The codes are separated by object type: Glass: When the glass is the foreign body, you’ll report an applicable code from the W44.C- (Glass entering into or through a natural orifice) code subcategories. Magnetic and non-magnetic metal: Starting October 1, you can accurately specify the material and the severity of the patient’s situation, if applicable, with magnetic metal and nonmagnetic metal codes. You’ll assign codes from W44.D- (Magnetic metal entering into or through a natural orifice) for magnetic metal objects and choose from W44.E- (Non-magnetic metal entering into or through a natural orifice) codes for nonmagnetic metal objects: Sharp objects: You’ll assign an appropriate code from the W44.H- (Other sharp object entering into or through a natural orifice) subcategory when the material is sharp but isn’t made of glass. Familiarize Yourself With ‘Other’ and ‘Unspecified’ Diagnosis Codes The W44.- code category also features the following “other” and “unspecified” code subcategories: “You’ll assign ‘other’ codes when a specific subset of the condition is known, but no code for the condition exists. On the other hand, ‘unspecified’ codes are for when there is not enough documentation to choose a more specific code,” Braico explains. Use a 7th Character to Specify the Encounter Type Each of the codes in the W44.- categories require a 7th character to complete the codes. You’ll choose from the following 7th characters to specify the encounter type: The W44.- codes are only five characters and require a 7th character, which means you’ll need a 6th character to complete the code. You’ll use the placeholder character “X” as the 6th character to expand the codes, as instructed by ICD-10-CM guideline I.A.4, which tells you that “Where a placeholder exists, the X must be used in order for the code to be considered a valid code.” For example, if a patient is seeking active treatment after accidentally swallowing a coin, you’ll assign W44.D2XA (Magnetic metal coin entering into or through a natural orifice, initial encounter). Examine This FB Scenario Scenario: Parents of a pediatric patient present to the emergency department (ED) with the child. The parents believe the child swallowed a small plastic toy building block. The provider performs a physical examination and the child appears normal. The provider orders a single-view total body X-ray to check for the foreign body. After interpreting the X-ray image, the physician identifies that the patient did swallow a building block and it should pass within a few days. For this scenario, you’ll assign T18.2XXA (Foreign body in stomach, initial encounter) and W44.B3XA (Plastic toy and toy part entering into or through a natural orifice, initial encounter) to report the provider’s findings. Why? Code W44.B3XA is an External Cause code, which means the code cannot be a primary diagnosis code. “The majority of primary codes you would use in this situation would be found in T15-T19. The W44.- codes are listed following the appropriate T15-T19 code,” Braico says. If the physician didn’t find the suspected foreign body on the imaging scan, you have a couple coding options for reporting the encounter. You can report a Z03.82- (Encounter for observation for suspected foreign body ruled out) if the physician rules out the suspected foreign body. However, in this situation, if the patient is experiencing signs or symptoms of a foreign body, such as pain in a specific area, then you can assign an applicable code or codes to reflect the documented symptoms. For situations where the imaging scan rules out a foreign body, you can check with your individual payer to see their preferred coding for the encounter. Pick out the procedure code: The provider ordered a single-view total body X-ray to see if the plastic toy was in the patient’s body. You’ll assign 76010 (Radiologic examination from nose to rectum for foreign body, single view, child) to report the procedure. This code is designated for a single-view X-ray of a child’s body from the patient’s nose to their rectum, so the provider can evaluate for the presence of a foreign body.
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