ED Coding and Reimbursement Alert

Eye, soft-tissue FBRs have different code sets With those carefree summer days fast approaching, careful ED coders should be brushing up on the basics of foreign-body removal (FBR) coding. As sure as firecrackers on Independence Day, more patients show up to the ED for FBRs in the summer months.

There are several code groups to represent FBRs, depending on the situation. Your FBR code choice will hinge on where the FB is located and what steps your physician takes to remove it. Check out this expert review of some of the more common FBR scenarios in the ED. Corneal FBR May Require Slit Lamp When a patient presents to the ED with a foreign body in his eye, you should first decide whether the FB was conjunctival or corneal, says Peggy Gunning, CPC, coding manager at TERM Billing Inc. in Mansfield, Texas.

For conjunctival foreign bodies, coders should report one of the following codes, depending on the location and penetration of the wound:

- 65205 (Removal of foreign body, external eye; conjunctival superficial). This type of FBR -may include removal of a superficial FB utilizing the beveled edge of a needle, a cotton tip applicator, forceps, tweezers or a spud,- Gunning says.

- 65210 (Removal of foreign body, external eye; conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating). This code refers to the procedure to remove an -embedded FB,- which is more complicated and may even require an incision. While the incision may penetrate the conjunctiva, it does not penetrate the sclera, Gunning says. When the patient presents with a corneal FB, your coding choices change. Coders should choose from these codes for corneal FBRs, depending on whether the physician used a slit lamp:

- 65220--... corneal, without slit lamp

- 65222--... corneal, with slit lamp. The ED physician typically uses a slit lamp if the FB is in the cornea. Often an eye FB -isn't readily visible to the examiner. By using the slit lamp, the doctor can be more certain that a microscopic FB hasn't been over-looked,- says Linda Martien, CPC, CPC-H, coding specialist at National Healing Inc. in Boca Raton, Fla. The physician may or may not incise the corneal tissue during a slit lamp FBR.

Example: A mechanic reports to the ED complaining of eye pain after doing some auto bodywork. After documenting a level-three ED E/M service, the physician examines the eye with a slit lamp, which reveals a small metallic foreign body in the cornea. The physician removes the foreign body, writes a prescription and arranges appropriate follow-up care.

On the claim, you should:

- report 65222 (Removal of foreign body; corneal, with slit lamp) for the FBR.

- append 930.0 (Corneal foreign body) to 65222 to represent the FB.

- report 99283 (Emergency department visit for the [...]