Coding for Foreign Body Removals from the Skin
By Stacie Norris, MBA, CPC, CCS-P, Director of Coding Quality Assurance, Zotec Partners
Foreign body removals (“FB removal”) from the skin are a common procedure provided in the Emergency Department setting. To code these FB removals with the correct, most accurate CPT code, the physician should document the location(s), tissue depth penetration and how the foreign body was removed. The physician should document any procedure details that made this FB removal more complicated or risky such as exploration and/or enlargement of the wound, debridement, etc.
The most highly utilized codes for reporting FB removals in the ED are:
- CPT 10120 (2.95 Total RVUs)-Incision and removal of foreign body, subcutaneous tissues; simple; and
- CPT 10121 (5.31 Total RVUs)-Incision and removal of foreign body, subcutaneous tissues; complicated.
CPT 10121 is to be used if the procedure is more complicated and requires the dissection of underlying tissues. One FB removal scenario that patients present with to the ED is for removal of an embedded fish hook. If it is a simple FB removal of the fish hook with no complicating factors, then CPT 10120 would be used. Note that the CPT definition states “Incision and removal” for both CPT 10120 and 10121. Therefore, in order for the fish hook removal to be billed as a separate procedure that is not included in the Evaluation and Management level, the physician would have to either make an incision in the skin with an instrument or have the fish hook itself make an incision when the physician pushes the fish hook out. If the fish hook is simply pulled out with no incision made, then it is not a separately billable procedure.
In addition to the codes listed above, there are also other options for integumentary FB removal, and the most specific CPT code should always be used. These options vary by site of the foreign body and by the tissue depth. CPT provides several site-specific FB removal codes, including the foot, shoulder, arm, elbow, hip and leg. These site-specific codes are available to be used if the foreign body is deep and/or complicated and the documentation supports this. The foot is a very common site for a foreign body and there are three FB removal codes available in CPT for foreign bodies in the foot:
- CPT 28190 (3.85 Total RVUs)-Removal of foreign body, foot; subcutaneous;
- CPT 28192 (9.02 Total RVUs)-Removal of foreign body, foot; deep; and
- CPT 28193 (10.63 Total RVUs)-Removal of foreign body, foot; complicated.
CPT has given somewhat conflicting guidance on these codes (which are located in the musculoskeletal surgery section of CPT) as the code description does state “subcutaneous” but yet in a CPT Assistant FAQ they state that the FB must extend into the fascia or muscle depth in order to use these codes. Provider tip: Providers should document the tissue depth of the foreign body penetration so that the most accurate CPT code may be coded.
The wound exploration codes are an option for more complicated FB removals. The examples CPT gives for when these codes might apply include trauma cases such as penetrating gun shots and stab wounds. These codes are to be used for more serious injuries, but could be used for FB removals if the documentation supports as the CPT definition specifically states FB removals are included in the work for these codes: CPT 20100 (17.51 Total RVUs)-Exploration of penetrating wound; neck, CPT 20101 (6.01 RVUs)-Exploration of penetrating wound; chest, CPT 20102 (7.34 Total RVUs)-Exploration of penetrating wound; abdomen/flank/back, and CPT 20103 (10.03 Total RVUs)- Exploration of penetrating wound; extremity. The RVUs for these codes are quite high, indicating the amount of work and complexity involved in these cases. Documentation should be robust to support the use of these codes.