Foreign Body Removal (FBR)
Overview
Foreign body removal (FBR) procedures are performed when a surgeon removes any object not part of the human anatomy. The coding of these procedures requires answering specific questions regarding the procedure details. Here, we focus on the CPT codes used, bifurcations based on organ system, site, and depth, and practical examples.
Key Questions for Coding FBR
Was an Incision Made or a Scope Used?
Was the FBR Incidental?
How Deep Was the Object?
Do You Need Modifiers?
CPT Codes for FBR
Subcutaneous Foreign Bodies
10120: Incision and removal of foreign body, subcutaneous tissues; simple.
Example: Removal of a glass shard from subcutaneous tissue.
Requirements: Incision without extensive dissection.
10121: Incision and removal of foreign body, subcutaneous tissues; complicated.
Example: Removal involving extended exploration or imaging guidance.
Requirements: More complex procedures, potential infection, or layered closure.
Q: The patient presented with a broken ring finger. It looked swollen, and we needed to use a ring cutter to take off her ring. Can we code any CPT for this scenario?
A: Taking off a ring from a finger by cutting it is part of the evaluation and management (E/M) code.
Musculoskeletal System Foreign Bodies
23330: Removal of foreign body, shoulder; subcutaneous.
Example: Removal from subcutaneous tissue of the shoulder.
23331: Removal of foreign body, shoulder; deep.
Example: Removal from muscle tissue of the shoulder.
Digestive Tract Foreign Bodies
43247: Upper gastrointestinal endoscopy, including removal of foreign body.
Example: Removal of a foreign body from the duodenum via endoscopy.
44010: Duodenotomy for exploration or foreign body removal (open procedure).
Example: Open removal of a foreign body from the duodenum.
Muscle or Tendon Sheath Foreign Bodies
20520: Removal of foreign body in muscle or tendon sheath; simple.
Example: Removal of a thorn lodged in the muscle.
20525: Removal of foreign body in muscle or tendon sheath; deep or complicated.
Example: Removal involving deeper dissection or presence of infection.
Foot Foreign Bodies
28190: Removal of foreign body, foot; subcutaneous.
Example: Simple removal from subcutaneous tissue of the foot.
28192: Removal of foreign body, foot; deep.
Example: Removal involving muscle or tendon tissue.
Q: The physician spent an hour searching for a foreign object in a foot. To find it, I had to make a 4 cm incision. Can we combine the code for the simple wound repair (12002) with the code for the complicated removal of a foreign object under the skin (10121)?
A: No, the wound repair is already included in the foreign object removal code. However, you can use the appropriate code for deep foreign object removal from the foot (28192) or the code for complicated foreign object removal from the foot (28193) based on the situation.
Detailed Examples and Requirements
CPT 10120:
Example: A patient has a small glass shard in the subcutaneous tissue of the arm. The surgeon makes a simple incision and removes the shard.
Requirements: Incision without extensive dissection.
CPT 10121:
Example: A patient has a metal fragment in the subcutaneous tissue of the leg, complicated by infection. The surgeon performs extended exploration, uses imaging guidance, and closes the wound in layers.
Requirements: Extended exploration, imaging guidance, or layered closure.
CPT 23331:
Example: A patient has a piece of rock embedded in the shoulder muscle. The surgeon makes an incision and removes the rock from the muscle tissue.
Requirements: Incision and removal from muscle tissue.
CPT 43247:
Example: During an upper GI endoscopy, a surgeon removes a small ball blocking a child's duodenum.
Requirements: Endoscopic procedure for foreign body removal.
CPT 20525:
Example: A patient has a bullet lodged deep in the muscle of the thigh. The surgeon performs extended dissection to remove the bullet and ensures complete removal using post-procedure x-ray images.
Requirements: Deep dissection and post-procedure imaging.
Modifiers and Specific Considerations
Modifiers: Use modifiers to indicate multiple removals or specific locations. For example, append modifier 59 (Distinct procedural service) for separate sites.
Unilateral Codes: For procedures like removal from the ear, report each ear separately using modifiers LT (Left side) and RT (Right side).