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.
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
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.