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Family Practice Coding Alert

Reader Questions:

Include Nonincision Tick Removal in E/M Service

Question: How should I submit the following claim?: A patient with a tick embedded in his shoulder came to our office. The family physician removed the whole tick, which was still alive. He sent the tick to a laboratory for testing and requested blood work for the patient. Should I code this as a removal or a biopsy, and what diagnoses should I report?

New Jersey Subscriber
Answer: You should not consider the removal of the tick as a biopsy. The FP did not remove any tissue for examination.
Most tick removals don't require incision. If this is true in your case, you should include the service in the appropriate-level E/M code (such as 99212-99213, Office or other outpatient visit for the evaluation and management of an established patient ...).
For the ICD-9 codes, you should report the site-specific superficial injury code with an E code to explain the injury's cause. Because the insect bite is on the shoulder, you should select 912.4 (Superficial injury of shoulder and upper arm; insect bite, nonvenomous, without mention of infection). To indicate that an animal caused the injury, assign E906.4 (Other injury caused by animals; bite of nonvenomous arthropod) as a secondary diagnosis.
Do not use a foreign-body removal code unless the FP removed the tick via an incision. In that case, consider using either 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) or 23330 (Removal of foreign body, shoulder; subcutaneous). 

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