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Dermatology Coding Alert

Reader Question:

NPPs Performing FBRs? Know the Rules

Question: A 44-year-old established patient reported with a splinter lodged in his foot, and the nonphysician practitioner (NPP) removed it. How should I code for the splinter removal?

Minnesota Subscriber

Answer: The coding for this scenario will depend on several questions. For coding purposes, the definition of foreign body removal (FBR) is that the provider must make an incision when removing the splinter.

Basically, if the provider performs the procedure without an incision, you’ll report the appropriate-level E/M code (99201-99215, depending on encounter specifics.) If the provider has to make an incision during the encounter, then you’d report 10120 (Incision and removal of a foreign body, subcutaneous tissues; simple) or, less frequently, 10121 (… complicated).

E/M example: After examining the patient’s foot, the NPP uses tweezers to remove the splinter. There is no evidence of an incision in the notes, and the overall encounter notes justify a level-three E/M service. In this instance, you’d report 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity…) for the service.

Simple FBR example: Encounter notes indicate that the NPP made a 2 cm incision near the splinter, and then removed the splinter with tweezers. For this service, you’d report 10120.

Although less common, your providers might also perform complicated FBRs in the office. An FBR could become complicated for several reasons, such as infected tissue, overall procedure time, need for fluoroscopy or x-rays to visualize the FB, use of extra personnel to identify and remove the FB, etc.

Complicated FBR example: The NPP starts removing a splinter from a patient’s foot. She makes a 3 cm incision near the wound, but still cannot grip the splinter with tweezers. The NPP calls on two colleagues for help: one to hold the light in the right spot, and one to hold a magnifying glass over the splinter. The NPP then successfully removes the splinter.

This might be a complicated FBR. Before coding 10121, be sure to check with your provider to ensure that you aren’t miscoding.