CODING Q&A Proper Coding for Removal of Foreign Bodies ■ DAVID STERN, MD, CPC Q . Recently we removed a tampon that was re- tained for one week. What is the code for re- moving a foreign body from the vagina? Although this procedure involves significant work, and the resultant foul odor can leave an exam room unusable for hours, the procedure is considered to be a part of the E/M. Of course, this is hard to understand, since there is a code for removing a foreign body from the external ear canal (69200) or the nares (30300). But coding is not always logical. One would hope that a code to compensate for the inconvenience and time spent on removing a vaginal foreign body will be developed. Until then, the procedure is not sep- arately compensable under the CPT coding system. A. Q . Recently, a woman presented with a fractured ring finger. The finger was quite swollen, and we had to cut off her ring with a ring cutter. What is the code for removing a ring from the finger? Once again, cutting off a ring from a finger is consid- ered to be a part of the evaluation and management (E/M) code. Of course, if you provide definitive treatment for the finger fracture, you should use the appropriate CPT code for treatment of the finger fracture, which will include 90 days of routine follow-up care. These codes depend on documentation of whether the fracture was open (i.e., had an associated break in the skin) or closed and whether the fracture was or was not manip- ulated by the treating physician, so make sure that you have a separate and identifiable procedure note that docu- ments these aspects of the treatment. A. David Stern is a partner in Physicians Immediate Care, with nine urgent care centers in Illinois and Oklahoma, and chief executive officer of Practice Velocity (www.practicevelocity.com), a provider of charting, coding and billing software for urgent care. He may be contacted at dstern@practicevelocity.com. w w w. j u c m . c o m If you refer the patient to another physician for the de- finitive treatment of the finger fracture, you can still code for the appropriate E/M level, the supply code for a finger splint (Q4049), and code for finger splint application (29130). Q . What is the code for simply removing a splinter with a forceps? With a few exceptions, if the removal requires no in- cision and if you simply remove the splinter with a forceps, then there is no specific CPT code for the splinter removal and the removal is included in the E/M code. In the case of larger splinters, I have personally seen several abscesses complicate supposedly simple splinter removal procedures. These abscesses occurred because the initial foreign body removal left a small retained splinter frag- ment. Thus, it is good clinical practice—when possible with- out risk to deeper structures and especially with splinters from older wood—to make an incision and visualize the en- tire splinter prior to removal. This practice helps ensure that the entire splinter is removed and no splinter frag- ments are retained in the wound. If the foreign body is located in the skin (epidermis and dermis) and has not penetrated the subcutaneous tissues, then the removal of a foreign body never warrants a proce- dure code separate from the E/M code. A. Q . We had a patient step on a one-inch splinter and the doctor removed the splinter from the foot with a forceps. No incision was made. What code is ap- propriate? Here is where coding gets a little tricky and knowledge of the fine print can allow for better reimbursement. Unlike the generic code for simple foreign body removal from subcutaneous tissue (10120), the code for removing a foreign body from the subcutaneous tissue of the foot does not specifically require incision as part of the removal to use A. JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | O c t o b e r 2 0 0 7 39