Tag Archives: FBR
Surgical Coding: Follow Hernia Bundling Rules
Posted on 23. Apr, 2010 by Editor.
Did you factor in a foreign body removal code?
Question: During an open hernia repair for a reducible umbilical hernia, the surgeon finds a sizeable gallstone embedded in the omentum extending into the preperitoneal fat. The surgeon excises the gallstone granuloma with cautery. Patient history indicates cholecystectomy eight years ago. What are the correct ICD-9 and CPT codes?
Utah Subscriber
Answer: The proper procedure code for this scenario is 49585 (Repair umbilical hernia, age 5 years or older; reducible). If the gallstone resection represents a significant amount of extra time and effort, modifier 22 (Increased procedural services) would be appropriate.
Watch out: You should not report the omentum gallstone resection (49255, Omentectomy, epiploectomy, resection of omentum [separate procedure]) in addition to the 49585 hernia repair. As a designated “separate procedure” code, you should only list 49255 if it is the only procedure the surgeon performs at the site.
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Look for Incision Evidence in Foreign Body Removal (FBR) Scenarios
Posted on 28. Mar, 2010 by Editor.
Here’s why you should append modifier 25.
Question: A 47-year-old male reports to the ED complaining of a painful, swollen, and reddening right thumb. The physician performs an expanded problem focused history and examination, which uncovers two splinters. The ED physician cannot grasp the splinters with tweezers, so she uses a scalpel to make two small incisions above the splinters. The physician then uses tweezers to remove both pieces of wood. The notes do not indicate evidence of infection at the extraction site; medical decision making is moderate. Can I code this as a foreign body removal (FBR)?
Kentucky Subscriber
Answer: Since the physician made an incision before removing the splinters, this is an FBR. On the claim, report the following:
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Factor Location and Depth into Foreign-Body Removals
Posted on 15. Feb, 2010 by Editor.
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:
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Snag Summer Tick-Related Case Dxs With Insect Fast Facts
Posted on 24. Jun, 2009 by .
Think a tick is venomous? That error will land you with the wrong ICD-9 code(s).
Get the scoop you need to land all possible diagnoses for a tick removal or tick bite codes with this guide.
Go With 910-919 for Nonvenomous Bite
To support a tick bite or tick removal E/M or foreign body removal (FBR), the first diagnosis code you’ll need is the injury code. What caused the injury that requires care? A bite.
In the ICD-9-CM index, if you look up “bite: insect,” you’re faced with a dilemma. Is a tick venomous or nonvenomous? “Ticks can infect you but they don’t have venom like an ant mite,” notes Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine, Department of Pediatrics at Children’s Healthcare of Atlanta at Egleston.
AUDIO TRAINING EVENT: Seasonal Coding: Primary Care Summer Survival Guide, with Jen Godreau.
That specific information lets you choose “bite: insect, nonvenomous,” which directs you to the site-specific superficial injury codes (910-919). If you had incorrectly classified a tick as venomous, you would have ended up with a nonspecific diagnosis of 989.5 (Toxic effect of other substances, chiefly nonmedicinal as to source; venom).
Show Removal, Bite With 2 Injury Codes
Choose 910-919’s third digit based on the bite’s location. For instance, a bite on the forearm goes to “913.4 or 913.5 (Superficial injury of elbow, forearm, and wrist …) dependent on whether it is infected (5) or not (4)”, says Mary Forte, business administrator at Sewickley Valley Pediatric and Adolescent Medicine PC in Pennsylvania.
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Coding Challenge: Foot Foreign Body Removal Vs. Soft-Tissue FBR
Posted on 16. Jun, 2009 by .
Question: Our physician performed a foreign-body removal (FBR) on a patient with a splinter in the subcutaneous tissues of his left foot. We reported 10120 and received a denial. Should I appeal, or did I code improperly?
Answer: : In this case, there is a more specific code for a foot FBR. Code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) is in the “Integumentary” part of CPT’s “Surgery” section. It is for simple, subcutaneous incision and removal of foreign bodies when no more specific code exists.
For reporting subcutaneous FBRs from the foot, a more specific code does exist.
When your physician removes a foreign body from a patient’s foot, choose from:
• 28190 — Removal of foreign body, foot; subcutaneous
• 28192 — … deep
• 28193 — … complicated.
Ahhh, Summer. That’s means FBRs, sunburn diagnosis coding challenges, tetanus denials & more. Tackle them all with Jen Godreau’s Summer Coding Survival Guide.
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Know What Separates FBR From E/M or Lose $80 in Pay
Posted on 26. Feb, 2009 by .
Here’s why ‘incision’ with non-scalpel instrument could be an FBR.
If you cannot spot simple or complicated foreign body removal (FBR) qualifiers, you could end up costing the ED more than $80 for a simple removal, or more than double that per complex episode. Galvanize your soft-tissue FBR coding skills with this expert advice.
Follow CPT for FBR Definition
Coding for soft-tissue FBRs seems simple enough: A patient reports to the ED with an FB, the physician removes it, and you choose an FBR CPT code.
Not so fast: The above scenario might be an FBR, but it might also be an E/M service. To report one of the soft-tissue FBR codes, the encounter should fit the following description, from Joshua Tepperberg, CPC, EMT-D: The provider makes an incision to the overlying skin, and then removes the FB.
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