Radiology Coding Alert

Find out if implants can become foreign bodies.

Radiologists may find items when reviewing imaging scans — some that are intended as treatment and some that can cause harm to the patient. Deciphering therapeutic from troublesome is essential to making the correct code choice when reporting the encounter, and it’s easy to get confused.

Radiology Coding Alert researched some mystifying myths about foreign bodies and implants and uncovered the truth. Read on to learn about these misconceptions.

Myth 1: A Foreign Body Is Any Object in the Patient’s Body

The CPT^® guidelines differentiate objects in the patient’s body as either a foreign body or an implant:

• Foreign body: “An object that is unintentionally placed (eg, trauma or ingestion).”
• Implant: “An object intentionally placed by a physician or other qualified health care professional for any purpose (eg, diagnostic or therapeutic).”

In other words, an object is a foreign body if it’s found in the body, regardless of how it got there. An implant is purposely placed inside the body by a healthcare provider.

Myth 2: If an Implant Moves, it Doesn’t Become a Foreign Body

This statement is false because if implants break or loosen and move from their original position, the objects are considered foreign bodies.

Example: A 36-year-old patient presents for X-rays with complaints of acute right shoulder pain. The patient is a former athlete who had surgery about 8 years ago and had pins inserted in the proximal humerus. During a visit with the patient’s primary care provider (PCP), the PCP found a growth near the back of the shoulder. The radiologist captured anteroposterior (AP) and lateral X-ray views, which showed a broken pin near the back of the shoulder. A week later, a surgeon removed the pin from the patient’s shoulder.

In this example, one of the pins in the patient’s shoulder fractured over time and the broken piece migrated inside the body. This pin is no longer intact nor in its original position, but does that mean it can be considered a foreign body? In this case, yes, and the guideline tells you why.

The CPT^® guideline states that an implant is considered a foreign body for coding purposes if the implant “(or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient.”

Now that the broken piece is considered a foreign body, you’ll need to find the correct CPT^® code that best describes the removal procedure. If the provider removes the broken implant and there isn’t a CPT^® code that describes the implant removal, then you’ll opt for a foreign body removal procedure code, such as 23040 (Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of foreign body).

However, the CPT^® code set features a code specific to the broken implant removal as in the example presented. For this case, you’ll assign 20680 (Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)) to report the removal of the screw from the patient’s shoulder. You’ll assign 20680 only once on a claim, regardless of how many screws, pins, rods, etc., are removed.

According to the January 2018 issue of CPT^® Assistant, “Code 20680 describes a unit of service that is typically reported only once, provided the original injury is located at only one anatomic site, regardless of the number of screws, plates, or rods inserted, or the number of incisions required for removal.”

Lastly, you’ll need to report 73030 (Radiologic examination, shoulder; complete, minimum of 2 views) to ensure reimbursement for the X-rays of the shoulder.

Myth 3: Foreign Bodies Can’t Occur by Accident.

This myth is debunked by reviewing the guideline from the first myth. Foreign bodies are categorized as such when the items are unintentionally, or accidentally, placed in the patient’s body.

Scenario: A 56-year-old patient was remodeling their living room when a ceiling board suddenly fell on them. They experienced pain, swelling, and discoloration in their right shoulder for a few days before presenting to an urgent care clinic, where the physician ordered X-rays of the shoulder. The radiologist captured two views of the shoulder, which revealed a small item inside the shoulder. A physician performed a simple surgery to open the patient’s shoulder and remove a nail.