Eye These Codes for Ocular FBRs
Code for slit lamp use on some eye FBRs. The arrival of summer means people are working and playing outside more often. Outdoor activities and hobbies are rife with opportunities for something to lodge in the eye — an object or debris that doesn’t belong and can cause, at the least, immediate discomfort; and, at the worst, injury, infection, or loss of vision. The sensation of a foreign body in the eye will often result in a call to the ophthalmologist for an immediate appointment. But a patient may also seek care at the emergency department (ED), so ED coders must be familiar with the nuances of foreign body removal (FBR) coding. Read on for the information you’ll need when a physician performs an eye FBR in the ED. Identify FB Location The physician will first examine the surface of the eye, which is made up of two parts. The conjunctival membrane covers the sclera (the white of the eye) and the inner surface of the eyelid, acting as a protective barrier and producing tears for lubrication. The cornea is the dome-shaped tissue directly over the iris and pupil, through which light is refracted to pass through to the retina. A foreign body may be stuck to the surface of the eye or eyelid, or perhaps wedged into the space where the eye meets the lid. These are considered superficial, are easier to remove, and have few or no residual complications. An embedded foreign body will have pierced the surface of the eye, causing more pain and greater complications. The object may be minimally implanted, or it may have punctured deeply. The exam often makes use of a slit lamp, an ophthalmic instrument offering a clear, illuminated view of the surface of the eye, allowing the physician to locate any particles or debris, find the depth of the foreign body, and adequately determine the best removal method. When it comes to removal, all of this information is crucial to correctly coding the procedure. The FBR may be as simple as flushing the eye with saline or using the blunt end of a cotton swab to sweep the object away. Deeper objects require forceps or a needle to successfully draw out the object. Use These Codes for Eye FBR Removal of a conjunctival foreign body is determined by the location of the foreign body and whether it is superficial or embedded. Use 65205 (Removal of foreign body, external eye; conjunctival superficial) when the object is on the surface and easily swept away with a saline flush or a cotton swab. When something is lodged in the white of the eye or the inner surface of the eyelid and requires extraction by forceps, look to 65210 (… conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating). Corneal FBR codes are differentiated not by location of the object in the eye, but rather by the use of a slit lamp to aid in extraction. Code 65220 (Removal of foreign body, external eye; corneal, without slit lamp) applies when a foreign body can be safely removed without additional magnification. The physician may also apply fluorescein to indicate corneal irregularities when viewed through the slit lamp. Forceps or a needle may be necessary, depending on the depth of the foreign body. Code 65222 (… corneal, with slit lamp) encompasses any device employed under the guidance of the slit lamp. Metal shavings or filaments that become embedded in the eye may result in the appearance of a dark red or brown spot known as a rust ring. Rust rings are removed using a needle or an ophthalmic burr under the slit lamp; you’ll also code this procedure with 65222. Report an ED E/M With the FBR in Some Instances An exam is always necessary to locate a foreign body, ascertain the severity, and determine the removal procedure. Minor procedures like eye FBR include the evaluation for the condition to be treated, so can you report an eye FBR code and an ED evaluation and management (E/M) code? It depends. If the patient presented with irritation in both eyes, but only one eye required a procedure, an E/M is billable for the exam to rule out a foreign body in the opposite eye. If the patient has an infection that requires treatment in addition to the foreign body, an ED E/M may be applicable. If a superficial foreign body was easily removed after a brief exam and without use of a slit lamp, an E/M may not be appropriate, as the evaluation to determine the procedure is encompassed in the work units for the procedure code. If you report a separate ED E/M, choose a code from 99281-99285 (Emergency department visit for the evaluation and management of a patient …). Append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure) as appropriate, but remember that modifier 25 indicates a significant and separately identifiable procedure or service. If the foreign body is the only applicable diagnosis for both the E/M and the procedure, modifier 25 may not be warranted. Check with your individual payer to learn their preferences on this issue. On your eye FBR codes, be sure to append modifier LT (Left side) or RT (Right side) to indicate laterality. In the event of a bilateral extraction, use modifier 50 (Bilateral procedure) on the FBR code and don’t forget to double the fee. Also, be sure to assign the ICD-10-CM code(s) with the highest specificity. If an infection has developed, be sure to code that as well, and apply an external cause code and/or place of occurrence code, if known and applicable. Check out This Clinical Scenario A patient presents to the ED after mowing the lawn with complaints of bilateral irritation and feelings of grit in both eyes. The physician performs an ocular exam to adequately visualize the surface of the eye. They are found to have lawn debris adhered to the conjunctiva under the eyelid in the right eye. The ED physician removes the debris using a cotton swab, and no further treatment is needed. The physician does not find any debris in the left eye. The patient is discharged with instructions to use artificial tears as needed for discomfort, and to wear safety glasses during lawn mowing in the future. For this FBR encounter, you’ll report the following codes: Christine Killeen CPC, CPC-M, CPB, CPMA, COPC, Contributing Writer
