Foreign Body FAQ

No, removal of nasal packing would be included in the E/M code for the visit. However, if it did require repacking, then you would document epistaxis management, complexity as appropriate.

No, this would not count as nasal foreign body removal, as code 30300 is specific for a nasal passage foreign body removal. If it required an incision, then it would be appropriate to report 10120, which is a simple foreign body removal, subcutaneous tissue, requiring incision and removal.

No, you cannot bill/code a foreign body removal from the vagina, as it is included in the E/M of the visit and would not be coded/billed separately. It would have to be impacted and performed under anesthesia other than local to support CPT 57415. If there is a foreign body in the rectum, it is generally considered part of the E/M if it is removed, unless using an anoscope (CPT 46608 without anesthesia) or (CPT 45915 under general anesthesia).

Foreign body removal from pharynx (fish bone, popcorn kernel, etc) is a separately reported code, 42809, and should be documented as such. The E/M code would also be reported separately for this encounter, as appropriate.

Yes, there is a difference between irrigation and removal by instrumentation. Removal by irrigation is coded as 69209, which is 0 wRVUs, and removal by instrumentation is 69210, which is 0.59 wRVUs. 

No, this would not count as foreign body removal from the ear canal, as this code (CPT 69205) is specifically for the canal. It should instead likely be coded as a foreign body removal of the skin, subcutaneous, simple. (CPT 10120).

No, this would not count as a foreign body removal since no incision was made and would be included in the E/M. However, if an incision was required, it would be considered a foreign body removal and should be documented as such.

Yes, you can still report the attempted procedure with a specific modifier to indicate the reduction in service, and reimbursement varies by payer, often with a reduced payment. In emergency medicine, most unsuccessful procedures may be reported with modifier 52- Reduced services. Payment is generally about 50%. You should still thoroughly document the attempt as well as why it was unsuccessful, i.e., stopped at the discretion of a physician/qualified healthcare professional, patient request, or threatened well-being of the patient, etc.

No, this would not be reported as a simple foreign body removal. Location, depth, and complexity all matter for foreign body removal. There are multiple anatomical locations that have their own codes and require specific reporting requirements. The clinician must determine the depth of the foreign body removal to determine if the integumentary system or musculoskeletal system CPT codes are appropriate. See the table below for examples.

Yes, this could be considered a complex foreign body removal, 10121. A complex foreign body removal may require extended dissection or exploration, imaging guidance, and/or layered closure of the wound.  Documentation must reflect what is being performed to substantiate the selection of the code.

Yes, documentation of superficial versus embedded does matter. If the foreign body was embedded and required more aggressive measures of removal, i.e., burr, needle tip, or forceps, and was adherent to the conjunctiva, it would likely be considered embedded and be coded as CPT 65210. For simpler removal of a foreign body in the conjunctiva, CPT code 65205 would likely be more appropriate.

Yes, using a slit lamp to aid in the removal of an ocular foreign body of the cornea does matter. CPT 65220 is the removal of a foreign body, external eye, cornea without slit lamp, and CPT 65222 is the removal of a foreign body, external eye, cornea with slit lamp. If there are 2 or more foreign bodies within the same tissue, they would all be bundled together. However, if there are both corneal and conjunctival foreign bodies that require removal, those would be separately reported, as they are in different locations and have different codes.

Yes, this also counts as an additional foreign body removal. CPT 65435 would be reported for this procedure. However, if the patient presented with metal in the eye and a rust ring, and both were removed on the same visit with a slit lamp, the procedure would be 65222.