Superb coding tips for Foreign body removal cpt code

Foreign body removal cpt code for different cases

Your foreign body removal cpt code can vary greatly depending on the type of foreign body, its anatomic location, and the depth from which the physician removed it. Here are five case studies to help you find your way.

Case 1: No Incision Means No Separate Foreign body removal cpt code (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.

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The solution: Because the physician did not create a separate incision to remove the foreign bodies, you cannot code an Foreign body removal cpt code. 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 ...).

Superb coding tips for Foreign body removal cpt code

 
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. These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which will surely help in clearing CPC exam.
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 judgement. If the wound is infected, as in this case, or shows other complications, 10121 may be more appropriate than the "simple" code (10120).

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Case 3: For Deeper Removal, code from Musculoskeletal section

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.
CPT 's "Musculoskeletal System" section (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).

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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 Foreign body removal cpt code 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.

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Case 4: Foreign body removal cpt code From Stomach? Choose 40000 Series

The situation: An 8-year-old child swallows a small battery. Using an endoscope, the physician removes the foreign body from the child's stomach.
The solution: You will find Foreign body removal cpt code for endoscopic removal from the intestine, stomach, colon, rectum, and other sites in CPT 's "Digestive System" section (40000 series).

In this case, for example, you should report 43247 (Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with removal of foreign body).
 
The "what if" scenario: The physician cannot safely remove the foreign body from the child's stomach using the endoscope and must create an incision to retrieve the object.
The 40000 series also contains codes to report open explorations for FBR at specific sites. For example, the code for open FBR from the stomach -- and the correct code in this instance -- is 43500 (Gastrotomy; with exploration or foreign body removal).

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Case 5: Scope May Not Call for Separate Code

The situation: The physician manually removes a previously placed percutaneous endoscopic gastrotomy (PEG) tube.

The solution: Although the PEG tube is technically a foreign object (in other words, it is not a natural part of the patient's body), CPT classifies PEG tube removal as an incidental service and does not contain a code to describe the procedure. Therefore, the physician may report only appropriate- level E/M codes to describe his service.

The "what if" scenario: During a manual PEG tube removal, a piece of the tube breaks off. The physician must use the endoscope to retrieve the broken portion of the PEG tube from the patient's stomach.
In this case, you may use the endoscopic Foreign body removal cpt code 43247.

Rationale: Although Chapter 6 of the National Correct Coding Initiative Policy Manual for Medicare Services stipulates that CPT code 43247 "should not be reported for routine removal of previously placed therapeutic devices," this is not a "routine removal."

In this case, there is no way to remove the portion of PEG tube manually. Your documentation should make clear, however, the necessity of using the scope to retrieve the portion of the broken tube. Without documentation, the payer will likely reject the claim.

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