# Rust Ring Removal



## cpccoder2008 (Jun 3, 2010)

I have a patient who had a rust ring removal with burr and slit lamp. I was looking at 65222 since the rust ring is considered a foreign body, then came across an ophthalmology coding alert that says to use 65435 instead.


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## cpccoder2008 (Jun 3, 2010)

According to an article posted in the Coders Edge magazine "If a patient is seen with a FB and is removed with slit lamp you use 65222, if the patient develops a rust ring several days later you use 65222 again." The May 2010 coding alert says " A patient has a FB removed using a burr and slit lamp and to use 65435 " Can anyone give me clarification on the two senario's please ?


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## RebeccaWoodward* (Jun 3, 2010)

Does this help?

CPT Assist Dec 2009

*Q*: When a rust ring is removed from the cornea by scraping or using a drill (burr) at the time of foreign body removal, is it appropriate to report both codes 65222 and 65435?

*A*: The removal of rust ring on the same day as the corneal foreign body removal is considered an inclusive component of the procedure,  therefore, should not be reported in addition with code 65222. However, if another procedure, i.e., epithelium removal, is performed on a 2nd or subsequent day, this procedure would include the rust ring removal, and can therefore, be reported using code 65435.

*Q*: Can code 65435 be reported for rust ring removal of cornea when no foreign body is found or removed? 

*A*: No. Since the rust ring is considered foreign to the cornea, the removal is reported either using code 65220 or 65222 as appropriate.


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## cpccoder2008 (Jun 3, 2010)

So if a patient has a fb and rust ring and the physician's removes both you only report 65222. But if a patient develops a rust ring after the removal then you report 65220 or 65222. Correct ??
I was always under the impression that a rust ring was considered a fb and you code 65222 when removed with slit lamp but according to the coding alert you use 65435. 

Here is the article:

Question: Our ophthalmologist removed a rust ring from a patient's central cornea, using a slit lamp and a burr. Would 65400 be the code for removal of the rust ring, or would 65222 be more appropriate?

Answer: Code 65435 (Removal of corneal epithelium; with or without chemocauterization [abrasion, curettage]) is the code that most accurately describes the work being done here. To remove a rust ring, the ophthalmologist uses a burr to scrape away the rust-impregnated corneal epithelium.

Even though the rust ring is a foreign body, don't be tempted to report 65222 (Removal of foreign body, external eye; corneal, with slit lamp) as the most appropriate code. Code 65400 (Excision of lesion, cornea [keratectomy, lamellar, partial], except pterygium) is also not appropriate since the ophthalmologist is removing a foreign body, not a lesion.

Don't forget to append the proper modifier -- LT (Left side) or RT (Right side) -- to specify which eye the ophthalmologist worked on.


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## RebeccaWoodward* (Jun 3, 2010)

I'm still leaning towards 65222...Per the AAO

*Foreign Body*
CPT code 65222 Removal of foreign body, external eye; corneal, with slit lamp

This code has a zero-day global period, which means that when the physician sees the patient a few days later, it is a billable exam. The procedure is payable per eye, not per foreign body. *And, in the event a rust ring develops, 65222 is the appropriate code to use again.*

http://www.aao.org/yo/newsletter/201005/article01.cfm


http://www.aao.org/publications/eye...commonspot/security/getfile.cfm&PageID=100040

Personally, I thought question 1 in the CPT Assistant was a little confusing but the Q/A for #2 suggests to use 65220/65222 for a rust ring, also.


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## cpccoder2008 (Jun 3, 2010)

*Agree*

I completley agree but still confused on why the ophthalmology coding alert says different. According to them to remove a rust ring, the ophthalmologist uses a burr to scrape away the rust-impregnated corneal epithelium (65435) But according to Savy Coder a rust ring is a FB therefore 65222 should be used.


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## cpccoder2008 (Jun 17, 2010)

I would love feed back from others to know what CPT code you use for Rust Ring Removal.  Thanks


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## bstrom (Jun 22, 2010)

*Rust ring and foreign body removal*

According to the NCCI edits the 65222 (foreign body removal) is not bundled into the 65435 (Rust ring removal with alger brush). Nor is it considered mutually exclusive according to the NCCI edits.

The doctor has removed the foreign body with a burr and then removes the ring with a alger brush.


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## PEGGYBRYANT (Jun 24, 2010)

We used to code both 65222 & 65435 however through an in-depth review with Todd from ER Coder along with the update in the coding alert we only code for the foreign body removal.


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## cpccoder2008 (Jun 28, 2010)

PEGGYJO said:


> We used to code both 65222 & 65435 however through an in-depth review with Todd from ER Coder along with the update in the coding alert we only code for the foreign body removal.



According to the AAO you only code 65222. They state a rust ring is considered a foreign body therefore should be coded as one. Thanks


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## cpccoder2008 (Nov 1, 2010)

*65222 ??*

I am still confused on the whole foreign body and rust ring removal. I have two scenarios, 1. The Doctor removed the foreign body, under slit lamp, with a cotton swab and a burr grinder for partial removal of rust ring. 
2. A patient was seen the in ER two days ago and the doctor removed the corneal foreign body and today is seen by the ophthalmologist and has a rust ring which they removed using a burr under slit lamp.

How would you code these two scenarios ? Would they both be 65222 ?


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## cpccoder2008 (Oct 26, 2012)

This is what i found under CPT assitant

Surgery: Eye and Ocular Adnexa 

Question: 

Can code 65435, Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage), be reported for rust ring removal of cornea when no foreign body is found or removed?  Donna Allshire, CPC, CPC-H, CPC-I, CEDC, RCC 

Answer:  

No. Since the rust ring is considered foreign to the cornea, the removal is reported either using code 65220, Removal of foreign body, external eye; corneal, without slit lamp, or 65222, Removal of foreign body, external eye; corneal, with slit lamp, as appropriate.


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