Wiki Exploration of extremity wound

[jhartung]

I have coded 20103 for the exploration of a penetrating finger wound in the emergency room and the special investigations department at the insurance company called me and told me I cannot bill for the exploration of the finger because the finger is not an extremity. Is this true?

 

[plasticscoder]

The upper extremity does include the hand/fingers. However, sometimes payers base their rationale to deny a code based on the work performed. If they have determined that a different code should have been billed, they will not tell you that, nor will they assist you with what code to bill [ie. a code with lesser RVUs]. Could you post the op report so that we may review?