11/16/2016

Billing For Splinter Removal-Subsequent Visit

CPT Code 10120 for removal of foreign body denied for diagnosis mismatch. What would be a proper code for subsequent visit for splinter removal? I used S90.851D.

The denial from Crossroads Healthcare Management is incorrect. This is a diagnosis that is valid in its specificity for a foreign body removal (or splinter in lay terms). The insurance should be called to request an adjustment of the denied claim. If they refuse to reprocess the claim for a common diagnosis for this minor procedure, a medical policy that they reference to base their medical necessity guidelines must be given so a corrected claim can be resubmitted.