Optometry Coding & Billing Alert

Published on Wed Dec 12, 2012 PDF

Don’t automatically code each FB separately, say experts.

If a patient has multiple foreign bodies in the eye, can you code each one separately? The answer, coding experts say, depends on the specific scenario.

Scenario 1: Multiple FBs in Right Cornea

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.

For foreign bodies in the cornea, report one unit of 65220 (Removal of foreign body, external eye; corneal, without slit lamp) or 65222 (… corneal, with slit lamp), depending on whether you used a slit lamp to remove the foreign bodies. Append modifier RT to indicate which eye was treated.

Scenario 2: FBs in Right Conjunctiva and Right Cornea

In the National Correct Coding Initiative, the codes concerning FBs in the conjunctiva, 65205 (Removal of foreign body, external eye; conjunctival superficial) and 65210 (… conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating), are not bundled with corneal FB codes 65220 and 65222. This means you are free to report both codes -- 65210 and 65222, for example -- separately.

Tip: Send along documentation clarifying that the FBs were in different parts of the eye. But insurers don’t always see it that way -- some will pay for only one removal procedure. Your strategy? Code the one that has the highest fee -- in this case, the corneal FB removal (65222-RT).

Scenario 3: FBs in Both Corneas

If you remove foreign bodies from the right cornea and the left cornea, report both removals -- report 65222-RT and 65222-LT, or 65222-50 (Bilateral procedure).

Medicare payers will reimburse 150 percent of the fee schedule amount for 65222 performed bilaterally. Based on the 2012 fee schedule, 65222 performed unilaterally should reimburse $75.22 (before geographic adjustments are factored in). Claiming 65222-50 should yield $112.83.

Key: To find out if any CPT^® code is bilateral or unilateral, you can check your Medicare fee schedule, says Sylvia Conrad, insurance coordinator with Your Eye Solution in Jacksonville, Fla. You can find the bilateral indicator in column "Z" ("Bilat Surg") of the Physician Fee Schedule spreadsheet.

Scenario 4: FBs in Right Cornea and Left Conjunctiva

Since the FBs are in different eyes, you can report one unit of 65205-LT or 65210-LT along with one unit of 65220-RT or 65222-RT. Your practice should earn the full amount for both codes.