ED Coding and Reimbursement Alert

Also, check for slit lamp on corneal FBR claims A patient with a foreign body in her left eye reports to the ED. The ED physician removes the FB and sends the patient home. This might look like a simple coding scenario, but there's more to reporting ocular foreign body removal (FBR) than meets the eye. When coding for these encounters, zoom in on three details: - the wound's depth - the FB's location - the instrumentation. Read on for more information on coding eye FBRs. Ask if Conjunctival FB Is -Embedded- or Not ED physicians will typically treat two types of eye FBRs: conjunctival and corneal. On conjunctival removals, coders need to check if the FB was superficial or embedded, says Pamela McKinley, RHIT, coder at Medical Accounts Services in Frederick, Md. When the ED physician removes a superficial FB from the patient's conjunctiva, report 65205 (Removal of foreign body, external eye; conjunctival superficial) for the service. For embedded conjunctival FBRs, choose 65210 (- conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating). The differences: "A superficial FB is exposed to the surface and generally easily moved with a cotton swab," says David Gibson, DO, a practicing optometrist in Texas. To remove a superficial FB, the ED physician might use a swab, tweezers or an instrument called a "golf spud" (because it looks like a tiny golf club), he says. "Embedded FBs extend into the conjunctiva," Gibson says. The physician will likely use a needle or spud to dislodge the FB, and the spud or tweezers to capture it. "The deeper the FB is, the more likely you-ll need a needle to dislodge it," he says. Example: A patient complaining of odd sensations in his right eye reports to the ED. The patient says that he was within a few feet of an exploding light bulb earlier that day. On the patient's conjunctiva/conjunctival sac, the ED physician finds a tiny shard of glass, which he grabs and removes using tweezers. This is an example of a superficial FB, McKinley says. On the claim, report the following: - 65205 for the FBR - 930.1 (Foreign body in conjunctival sac) linked to 65205 to represent the FB - E914 (Foreign body accidentally entering eye and adnexa) linked to 65205 to represent the cause of the injury. E/M alert: Most ED presentations for FBR will also result in a separately reportable E/M service. If you do code for a separate E/M in this scenario, be sure to 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 it is a separate service. Instrumentation [...]