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Q&A: Coding for procedure to remove splinter in the ED

JustCoding News: Outpatient, March 10, 2010

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QUESTION: A patient came to the ED after a palette fell on his right index finger at work. Examination of the right index finger shows a protrusion of a wood splinter. The entrance wound is on the right index finger, flexor surface of the proximal phalanx.

The provider cleansed the finger with chloroclens. To provide anesthesia for the entire finger, the provider then injected 1% xylocaine plain at the metacarpophalangeal joint. The provider then turned the patient’s hand over to look at the flexor side. The splinter would not move when the provider attempted to extract it. Therefore, the provider excised along the line of the splinter approximately 0.5 cm. The provider was then able to remove the splinter. Is it correct to report the following codes:

  • 919.6 (Superficial foreign body [splinter] without major open wound and without mention of infection)
  • E920.8 (Accident caused by other specified cutting and piercing instruments or objects)
  • E849.3 (Industrial place and premises)
  • 86.05 (Incision with removal of foreign body or device from skin and subcutaneous tissue)

ANSWER: I agree with your E codes. However, diagnosis code 919.6 reports superficial foreign body (splinter) without major open wound and without mention of infection in other, multiple, and unspecified sites. According to the scenario you presented, code 915.6 (Superficial foreign body [splinter] without major open wound and without mention of infection in finger[s]) is more accurate because it specifically indicates the finger.

Regarding the procedure code you selected, are you certain the third-party payer wants you to report ICD-9-CM volume 3 procedure codes for procedures performed in the ED? The ED is considered an outpatient facility and therefore, services provided to patients who are not ultimately admitted into the hospital are more typically reported with CPT codes.
 
With that said, procedure code 86.05 (Incision with removal of foreign body or device from skin and subcutaneous tissue) seems to report a more intensive surgical event than documented in your scenario. CPT code 10120 (Incision and removal of foreign body, subcutaneous tissues; simple) is the most accurate choice.

Editor’s note: Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA, of Safian Communications Services in Orlando, FL, answered this question. She is a senior assistant professor who teaches medical billing and insurance coding at Herzing University Online in Milwaukee, WI. E-mail her at ssafian@embarqmail.com.

This answer was provided based on limited information submitted to JustCoding.com. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.



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