Wiki foreign body removal

[flipden5]

Good afternoon, I am looking for some advice. We have a patient with a foreign body in right forearm. This item was a projectile from machinery at work. The provider is stating complex foreign body removal. cpt 10121, 20103 or 20525? I think cpt 10121 doesnt seem to be extensive enough. Here is the note:
I tried to remove the foreign body from the wound that was there and I could not get it. I then opened the wound proximally and distally. I was able to dissect down to the fascia of the extensor muscles and then did find the piece of metal deeply embedded. I was able to remove it. It was quite deep. I felt it was best to close the wound. This was done with multiple 3-0 Vicryl deep sutures and a 3-0 Vicryl subcuticular skin closure. This was a complex type foreign body with the depth of the wound and difficult nature to get it out.
Thank you

 

[Cynthia Hughes]

Here is my understanding. If you have access to CPT Assistant, there are articles from December 2013 and June 1996 that may be helpful in this determination. If the foreign body penetrated the fascia, the musculoskeletal code 20103 (5.34) is supported by the necessity of enlarging the wound to locate and remove the foreign body from below the subcutaneous tissue. If the foreign body was in the subcutaneous tissues between the dermis and the fascia, the integumentary code 10121 (1.22 work RVUs) is reported. As your can see with the work RVUs, there is a significant difference in the work of these two procedures.

I hope that helps,
Cindy

 

[CBLENNIE]

We have a patient with a foreign body in right forearm. This item was a projectile from machinery at work.

I would say this is likely a worker's comp case and you need to follow up with the patient about whether they filed a workers claim for this injury because if they have commercial insurance, Medicare or Medicaid, and they find out this was work related they are going to deny the claim for worker's comp information. That being said, if it is workers comp, they don't follow anything near normal for coding guidelines and you will need to find out how they want the claim billed/coded for reimbursement.

A lot of patients don't realize they have to file a claim with worker's comp, even if it it gets denied eventually in order for their commercial insurance, Medicare or Medicaid to cover the service.