ED Coding and Reimbursement Alert

CPT sports codes for both conjunctival and corneal foreign-body removals

If a patient reports to the ED with a foreign body in her eye and your physician performs a foreign-body removal, the coder must discover the type of removal, the location of the FB, and the depth of FB penetration before selecting a CPT code.

Why? Code choice for eye FBRs depends heavily on these three factors. Further, coders should remember to use the proper diagnosis codes on these claims to ensure success. Read on for some expert tips on filing clear and concise eye FBR claims. Know What Constitutes an -Embedded- FBR Two main types of eye FBRs are performed in the ED: FBR from the conjunctiva and FBR from the cornea.
 
When your physician removes a conjunctival FB, check the notes to see if the FB was superficial or embedded, says Jeffrey F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG in Egleston, Ga.
 
If the physician removes a superficial conjunctival FB, you should report 65205 (Removal of foreign body, external eye; conjunctival superficial). If she removes an embedded FB from the conjunctiva, use 65210 (... conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating).

How can I tell? A superficial FB may also be referred to in op notes as a -loose- FB. -This type of FB would be one lying just on top of the conjunctiva [and] can easily be removed with a moistened cotton-tipped swab,- Linzer says.

Conversely, -embedded FBs sit in the conjunctiva itself but have not penetrated the anterior chamber,- Linzer says. Physicians may be able to remove embedded FBs with a moistened swab, -but sometimes the FBs will need to be scraped out with a swab or needle,- he says.

Example: A construction worker reports to the ED with a swollen and puffy right eye. The physician examines the patient's eye and sees specks of debris atop the patient's conjunctival sac. She removes the debris using a cotton swab.

On the claim, you should:

- report 65205 for the FBR.
- attach ICD-9 code 930.1 (Foreign body in conjunctival sac) to 65205 to prove medical necessity for the procedure.

Different Code Set Governs Corneal FBRs The CPT book also contains codes for corneal FBRs. When the physician removes an FB from the cornea, you-ll need to check the op notes for the method of removal before you choose a code, Linzer says.

If the ED physician removes an FB from a patient without using a slit lamp, report 65220 (... corneal, without slit lamp). When the doctor needs to use a slit lamp for the FBR, report 65222 (... corneal, with slit lamp) instead.

Example: A patient reports to the ED complaining of pain in his left eye. The physician [...]