Ophthalmology and Optometry Coding Alert

Medicare may not like these codes - but emergency FB removals may be worth an extra $50

Treating ophthalmic emergencies in the office is difficult - so your office should get more reimbursement, right? Unfortunately, that's not always the way Medicare sees it, but our expert advice will help you get fair reimbursement for the ophthalmologist's extra work.

When a patient rushes in with a corneal laceration from glass stuck in his eye, you know that the ophthalmologist needs more time and skill than usual to deal with the traumatic eye injury. Yet Medicare has strict rules for coding ophthalmic emergencies in the office.

Some of the most common traumatic eye injuries ophthalmologists might treat in the office are foreign body (FB) removals (65205-65222) and laceration repairs (65270-65286). The code to report depends on the location of the FB and the resulting repair, if any.

For example, report 65205 (Removal of foreign body, external eye; conjunctival superficial) for a conjunctival FB and 65220 (... corneal, without slit lamp) or 65222 (... corneal, with slit lamp) for a corneal FB, says Shirley Laughman, coder and accounts receivable manager at the Campus Eye Center in Lancaster, Pa. Include FB Removal in Corneal Repair In some cases, the ophthalmologist must repair a laceration after removing a corneal FB. If you perform a laceration repair, use 65275 (Repair of laceration; cornea, nonperforating, with or without removal foreign body). Note that the code definition includes "with or without removal foreign body." This prevents you from reporting the FB removal in addition to 65275, even in the absence of a National Correct Coding Initiative bundle, says Carissa Baumhardt, CPC, coder and surgical coordinator at Ophthalmology Consultants in St. Louis.

When the FB is in the eyelid, use 67938 (Removal of embedded foreign body, eyelid). CPT says this procedure is blepharoplasty and must involve more than the skin. Code 67938 must involve the lid margin, tarsus or palpebral conjunctiva.

Watch out: You might be tempted to use 65235 (Removal of foreign body, intraocular; from anterior chamber of eye or lens) and 65260 (... from posterior segment, magnetic extraction, anterior or posterior route), but remember that these are "facility-only" codes, usually performed in a hospital or similar facility, not in the ophthalmologist's office, Laughman says. Reserve Special Services Codes for Private Payers Treating traumatic eye injuries in the office often requires extra work from the ophthalmologist, which CPT recognizes by including 99058 (Office services provided on an emergency basis) to reflect the additional time and skill needed. CPT also contains a series of "after-hours" codes for services the ophthalmologist provides outside normal office hours:
   99050 - Services requested after posted office hours in addition to basic service
   99052 - Services requested between [...]