Factor Location and Depth into Foreign-Body Removals

Explore these three “what if” scenarios to perfect your FBR claims.

Your foreign-body removal (FBR) coding can vary greatly depending on the type of foreign body, its anatomic location, and the depth from which the physician must remove it. Here are three case studies to help you find your way.

Case 1: No Incision Means No Separate FBR

The situation: While operating a metal lathe, the patient embeds several small metal filings in his shoulder. In the office, the physician inspects the wounds and, using tweezers, extracts the shards.

The solution: Because the physician did not create a separate incision to remove the foreign bodies, you cannot code an FBR. Rather, you should include the removal of the metal filings as a component of whatever E/M service the physician documents (for example, 99213, Office or other outpatient visit for the evaluation and management of an established patient …).

The “what if” scenario: The patient received deep wounds when he was hit by flying debris from an exploding propane tank. The physician explores the open wounds, removes several pieces of debris, and debrides and closes the wounds.

In this case, the physician performed wound exploration (20100-20103) with removal of the foreign body, which you should report using the wound exploration code that best describes the anatomic location of the wound the physician explored (such as 20101, Exploration of penetrating wound [separate procedure]; chest). Removal of foreign bodies is included in wound exploration codes.

Case 2: Turn to Integumentary Codes for Removal Just Beneath Skin

The situation: The physician removes a small metal pellet embedded underneath the skin.

The solution: In this case, because the removal occurs from just beneath the skin, you should turn to 10120 (Incision and removal of foreign body, subcutaneous tissues; simple).

The “what if” scenario: As above, the physician removes a small metal pellet embedded beneath the skin, but in this case the wound is severely infected. Here, the better code choice may be 10121 (… complicated).

Whether you should choose the “simple” or “complicated” code depends on your physician’s clinical judgment. If the wound is infected, as in this case, or shows other complications, 10121 may be more appropriate than the “simple” code (10120).

Case 3: For Deeper Removal, Look to Musculoskeletal Codes

The situation: The patient in Case 1 removes the metal filings himself. After several weeks, his wounds heal, but one metal filing remains and has now become imbedded beneath the skin and into muscle. The physician sees the patient and removes the foreign body from the patient’s shoulder through an incision.

The solution: When reporting FBR from a musculoskeletal site (muscle or even bone), you must select the correct FBR code by anatomic location and depth.

The CPT’s musculoskeletal portion (20000-29999) includes specific FBR codes for the shoulder, humerus (upper arm) and elbow, hip, femur (thigh region) and knee joint, and feet and toes. CPT further defines these codes according to depth (such as subcutaneous, deep or, in some cases, complicated).

Example: For FBR in the shoulder, you must select among codes 23330 (Removal of foreign body, shoulder; subcutaneous), 23331 (… deep [e.g., Neer hemiarthroplasty removal]), and 23332 (… complicated [e.g., total shoulder]). If the physician removes the foreign body from the subcutaneous tissue or anywhere else above the fascia, you would select 23330.

If the physician must go below the fascia, use 23331. In the case of a particularly complex procedure (such as when the whole shoulder area is involved), you should select 23332.

In Case 2, your best code selection is 23331.

The “what if” scenario: The physician must remove a foreign body from just above the fascia near the navel.

Because CPT does not contain a specific code for FBR from the abdomen, you must select between 20520 (Removal of foreign body in muscle or tendon sheath; simple) or 20525 (… deep or complicated). You would also select these codes for other unlisted areas, such as head, neck, flank, spine, wrist/forearm, and fingers.

In this case, you would select 20520 because the foreign body was not below the fascia.

Complete your FBR coding knowledge by examining two more cases in the General Surgery Coders Survival Guide, which you can access at Supercoder.com.

Bonus: Be a surgical coding hero. Join expert editor Leesa A. Israel, CPC, CUC, CMBS for a special Surgical Modifier Round-up For Specialty Coders audio conference. Reserve your spot today!

Related articles:

1. Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBRQuestion: Our physician performed a foreign-body removal (FBR) on a…
2. Know What Separates FBR From E/M or Lose $80 in Pay Here’s why ‘incision’ with non-scalpel instrument could be an…
3. Burn Coding: Calculate Total Body Surface Area (TBSA)Investigate your physician’s documentation to determine the body area percentage…