“What constitutes the difference between CPT 10120 and CPT 10121 – simple subcutaneous versus complicated subcutaneous foreign body removal?
Take for example a patient is seen in the clinic with a splinter that I was unable to retrieve simply. Instead, it required local anesthesia and deep probing but no incision or suturing. I removed a 2 centimeter wood splinter. It was subcutaneous, it was “more complicated” than a typical splinter to retrieve (needing local and more than usual probing) yet really wasn’t THAT complicated. How do you define complicated in this case? RVU values for CPT 10121 versus CPT 10120 seem to indicate there are very real differences between the two codes.”
When establishing the difference between the removal of a foreign body simple versus complicated, it is essential to access the CPT codes involved and the definitions of the respective codes.
CPT 10120 is defined as the following: Incision and removal of foreign body, subcutaneous tissues; simple.
CPT 10121 is defined as the following: Incision and removal of foreign body, subcutaneous tissues; complicated.
CPT 10121 reimburses approximately twice the reimbursement of CPT 10120 (4 versus 8 RVUs in the office setting). Obviously, it is expected that more work will be involved to justify the higher reimbursement. If a small incision or stab is made and the foreign body can be located and removed easily from within the subcutaneous tissues with or without the need for local anesthesia, this would certainly support the billing of CPT 10120.
With respect to CPT 10121, it is apparent that local anesthesia would be indicated as well as deep probing to identify the foreign body, in this instance a 2 centimeter wood splinter, and to safely remove the foreign body from within the subcutaneous tissue. The use of sutures for this procedure is really a non-issue. Obviously, more work is involved and overall, the procedure is certainly more complicated than what would be indicated for CPT 10120. CPT 10120 and CPT 10121 both have a postoperative global period of 10 days.
Let’s take this to the next level. There are additional CPT codes for the removal of a foreign body from the foot.
CPT 28190: Removal of foreign body, foot; subcutaneous
CPT 28191: Removal of foreign body, foot; deep
CPT 28193: Removal of foreign body, foot; complicated
CPT 28190 reimburses approximately for the same number of RVUs as CPT 10121. It also has a postoperative global period of 10 days. Both CPT 28191 and CPT 28193 are classified as major surgical procedure codes. They both have a postoperative global period of 90 days. They both reimburse at a significantly higher rate than either CPT 10121 and CPT 28190 and in all likelihood, they will need to be performed in a facility.
This is my opinion.
Michael G. Warshaw
DPM, CPC
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