Optometry Coding & Billing Alert

Published on Tue Feb 22, 2005 PDF

FB removal coding depends on the site - and on the whims of the carrier

"A consultant advised us to bill foreign-body removal separately for each foreign body removed," writes a biller from a Wisconsin optometry practice. "But I'm not sure that's right. If a patient has, say, two foreign bodies, shouldn't we bill only one unit of FB removal?"

The answer? It depends, says Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va. "For a complete answer on foreign-body removal, you have to look at four scenarios," he says.

Scenario 1: Multiple FBs in Cornea OD

If a patient has multiple foreign bodies in the same site in the same eye - for instance, the conjunctiva or the cornea - you can only report one procedure, no matter how many FBs you remove, Wimbish says.
 
For foreign bodies in the cornea, bill one unit of 65220 (Removal of foreign body, external eye; corneal, without slit lamp) or 65222 (... corneal, with slit lamp), depending on whether or not you used a slit lamp to remove the foreign bodies.

Good news: "If it's a new patient, you can probably bill a low-level E/M visit," Wimbish says. Append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code to show that it was separate and necessary.

Established patient                        New patient
65222-RT                                            992xx-25
                                                              65222-RT

Scenario 2: FBs in Conjunctiva OD and Cornea OD

Technically, you should be able to bill separately for removing foreign bodies from different sites in the same eye. But insurers don't always see it that way, Wimbish says. "If it's the same eye but different sites in that eye, some will pay for only one removal procedure," he says. Your strategy? Ask your carrier for its preferred method. If you can't bill both FBs, code the one that has the highest fee - in this case, the corneal FB removal. "There's really no need to code the second removal," Wimbish says. As before, if it's a new patient, charge an E/M visit.

Established patient                           New patient
65222-RT                                              992xx-25
                                                                65222-RT

Scenario 3: FBs in Corneas OU

If you remove foreign bodies from the right cornea and the left cornea, bill for both, and charge the full fee for each procedure, Wimbish says.

Established patient                           New patient
65222-RT                                              992xx-25
65222-LT                                               65222-RT
                                                                65222-LT

Scenario 4: FBs in Cornea OD and Conjunctiva OS

Since the FBs are in different eyes, you can bill one unit of 65205 (Removal of foreign body, external eye; conjunctival superficial) or 65210 (... conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating) along with one unit of 65220 or 65222, charging the full fee, Wimbish says.

Established patient                                  New patient
65222-RT                                                     992xx-25
65205-LT                                                      65222-RT
                                                                      65205-LT

Watch for: When charging an E/M visit with modifier -25, "be sure your record of care indicates that you performed two separate procedures," Wimbish says. "Some physicians use one sheet for the visit and another for the removals."