Query: Billing Sea Urchin Spine Removal
A 22 year old female stepped on a sea urchin a
week ago. She had 30 spines in her right foot.
Most (60%) of the spines were superficial
(exposed) while the remainder were deep. X-rays
were taken to attempt to localize all the
spines.
The doctor spend 2.5 hours operating to remove
all 30 spines from the right foot. After several
x-rays (including several intra-op) with needle
localization, a large incision (7.5 cm) was made
on the plantar right foot to localize and remove
the buried (embedded in fascia and muscle)
spines.
The patient has United Healthcare.
How should this be billed (CPT codes and ICD-9
codes)?
Cindy Soefer
Houston, TX
Codingline Response: I would recommend diagnoses
ICD-9 709.4 (foreign body skin and
subcutaneous tissue), ICD-9 959.7 (injury to
foot), and E906.8 (other specified injury caused
by animal).
I would recommend the following CPT codes:
1. The appropriate level E/M service with
modifier "-57" (decision for surgery); and
2. CPT 28193 (removal of foreign body foot,
complicated.
If desired, the doctor could append modifier "-
22" (unusual service) to CPT 28193 to indicate
an unusual effort and amount of time was
required to extract the multiple foreign bodies.
However, in my experience, adding "-22" may just
simply delay payment without increasing the
amount received.
Mark Schilansky, DPM
Catskill, NY
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