Are You Sure About that ‘Simple’ FBR? It Could Be an E/M

Posted on 30 Dec, 2015 |comments_icon 3|By Chris Boucher
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foreign-body-removal

Payers require specific criteria for 10120.

A patient steps on a splinter from a holiday tree, or some other foreign body (FB), and your physician performs a foreign body removal (FBR). You should choose an FBR code for the service, right?

Well … maybe: The service might not qualify for the CPT® definition of FBR, and in these cases you’ll have to choose the appropriate E/M code instead.

Check out this primer on coding basic FBRs to make sure your claims don’t splinter at the payer’s door.

Can’t Prove Incision? Choose E/M

For coding purposes, a simple FBR (10120, [Incision and removal of foreign body, subcutaneous tissues; simple]) occurs when the provider removes a foreign body embedded in subcutaneous tissue.

If the provider removes a simple FB without an incision, choose the appropriate E/M code instead (e.g., 99201-99205, 99211-99215, 99281-99285).

E/M example: An established patient reports to his primary care physician’s office for removal of a wood splinter from his left foot. The physician employs tweezers to remove the FB and bandages the patient’s foot. Notes indicate a level-two E/M service for the entire encounter.

In this instance, you should report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making) for the service.

See also: Key on Components for Accurate ROS Count

Incision Evidence Cinches FBR Code

If the notes indicate that an incision occurred, however, have 10120 at the ready.

FBR example: An established patient reports to the office for removal of a wood splinter from his left foot. The physician makes an incision on either side of the FB with a scalpel, and then employs tweezers to remove the FB.

In this instance, you should report 10120 for the service.

Author

Chris Boucher


Chris Boucher has nearly 10 years of experience writing various newsletters and other products for The Coding Institute. His blog will cover several areas of coding and compliance, including CPT® coding, modifiers, HIPAA compliance and ICD-10 coding.

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