Optometry Coding & Billing Alert
Use Caution With FB Removal and E/M
PDF
Question:
Alabama Subscriber
Answer:
No. Based on the information you provided, payers will consider the service your optometrist performed to be part of the foreign body (FB) removal.Why? You should code a separate E/M service only if the physician has to perform a separate E/M to assess another problem, or a separate E/M was medically necessary prior to performing the FB removal.
Determining the foreign body's location in the patient's eye is an integral part of the procedure, and payers include that service in the removal procedure.
You're correct that you should report the FB removal with an FB procedure code. In this case, report 65205 (Removal of foreign body, external eye; conjunctival superficial) linked to 930.1 (Foreign body in conjunctival sac).
If your optometrist performs a separate E/M service to evaluate another problem or condition, there must be separately identifiable documentation in the medical report to support both the service level rendered and medical necessity for the additional work separate from the FB removal. Then, you would report the appropriate E/M service level (99211-99215) appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).
Optometry Coding & Billing Alert
- 2 Tips Lead to Proper Glaucoma Visit Coding
Let form and severity drive your coding choice. Often, optometrists find themselves in a bind [...] - News You Can Use:
Breathe Easier Thanks to the Red Flags Rule Delay
You'll have more time to get your optometry practice in shape. If you're still trying [...] - E/M Corner:
ID All HPI Elements for Most Accurate E/M Coding
CPT, CMS don't see eye-to-eye on duration. Not accurately counting history of present illness (HPI) [...] - Correction:
An article in Vol. 7, No. 3 of the Optometry Coding & Billing Alert, "Prevent [...] - Better Collections Rates Start With Better Collections Skills
Well-trained billers may be your biggest assets toward improved collections. With the decreases in patient [...] - READER QUESTIONS:
Let Disease Damage, Control Drive VF Coding
Question: How often will Medicare allow visual field testing (92081-92083) on a patient? California Subscriber [...] - READER QUESTIONS:
Don't Just Cover Up Paper Claim Errors Question: When we make a mistake on a paper form,
Question: When we make a mistake on a paper form, can we just cross out [...] - READER QUESTIONS:
Use Caution With FB Removal and E/M
Question: A patient with eye pain presented to our office. This is a Medicare patient [...] - READER QUESTIONS:
Turn Over Records Even if Patient Owes You
Question: We have a patient with a large balance. She recently called our office and [...] - READER QUESTIONS:
Can Assistant Perform Laser Scan?
Question: What level of supervision is required for an ophthalmic assistant conducting a scanning laser [...] - You Be the Expert:
Primary Diagnosis for 'Foggy Vision'
Question: Many of our patients claim general reasons for their visit, such as "I can't [...]