Optometry Coding & Billing Alert

Published on Fri Nov 21, 2008 PDF

Question: A patient with eye pain presented to our office. This is a Medicare patient our optometrist has seen before for other problems. During this visit the optometrist performed a level-two E/M service and found an iron filing in the patient's

conjunctiva. The optometrist then removed the filing in the office. Can I report the foreign-body removal and 99212?

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 (99201-99215) or eye exam code (92002-92014) only if the optometrist 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.

However: It depends on what the chief complaint is. If the patient presents with eye pain but does not know the cause of the pain, an E/M service or eye exam is necessary to determine the need for an FB removal. But if the patient knows he

has something in his eye, report the FB procedure alone.

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 an 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 E/M service by the same physician on the same day of the

procedure or other service).