ED Coding and Reimbursement Alert
Look to These Codes for Eye FBR
If physician doesn’t find an FB, remember new Dx codes. Patients often report to the ED with something stuck in their eye. When this occurs, your physician will perform a foreign body removal (FBR) — provided they find a foreign body (FB). How you code the encounter will depend on several specifics. Details: You’ll have to decide which part of the eye contained the FB, and what type of FB the patient has. Read on to check out this rundown of how to code your eye FBRs. E/M Could Be the Code if Physician Finds no FB When a patient reports to the ED with suspected eye FBR, the provider will begin by performing an ED evaluation and management (E/M) service, which you’ll report with a code from 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making). This E/M could be a portion of the eye FBR service; if the physician goes on to perform eye FBR, you’ll code the FBR and then report the E/M with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to show that a significant, separately identifiable E/M led to the decision to perform the procedure. If, however, the physician doesn’t find an FBR, then there will be no need for surgery and you’ll only report the E/M. ICD-10 alert: If the physician diagnosis FB sensation, you’ll have some more specific codes to choose from when ICD-10 2024 takes effect October 1. Starting then, you’ll choose one of the following codes for FBR sensation, depending on encounter specifics: Use These Codes for Conjunctival FBR When the physician removes a conjunctival FB, coders should report 65205 (Removal of foreign body, external eye; conjunctival superficial) or 65210 (… conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating) depending on the location and penetration of the wound. A superficial FB “is something that can just be wiped away easily usually with a Q-tip. Embedded is something that is stuck in the conjunctiva and needs to be extricated,” explains Hamilton Lempert, MD, FACEP, CEDC, vice president of coding policy at TeamHealth. In addition to Q-tips, the ED provider might also use one of the following tools to perform eye FBR: tweezers, forceps, needle, burr, scoop, or “basically anything that the clinician can use to hold and manipulate the FB,” adds Lempert. Consider These Codes for Corneal FBRs For corneal FBRs, CPT® instructs coders to use 65220 (… corneal, without slit lamp) or 65222 (… corneal, with slit lamp) depending on slit lamp use. “The slit lamp is a microscope that emits a focused narrow, high-intensity beam of light. It may be used when examining the eye to find a FB or to identifying abrasions or other injuries to the eye caused by a FB,” explains Linda Martien, COC, CPC, CPMA, CRC, of Medical Revenue Cycle Management Consulting. Lempert reminds coders that the ED physician might also use a slit lamp for conjunctival FBs, but there is no separate CPT® code for the use of a slit lamp on these FBRs. “A slit lamp is used to get a better view of the eye so that a precise method can be used to remove a FB. It allows the clinician to see the eye and FB much better,” explains Lempert. The physician can decide to use — or not use — a slit lamp for a variety of reasons. “Sometimes it is personal choice whether to use a slit lamp or not. It depends on the patient’s cooperativeness, the clinician’s confidence, the FB in question, the exact location of the FB, the availability of a slit lamp — some EDs don’t have them or they may not be in working order — and other factors,” Lempert says. Examples: Lempert offers two scenarios; one that illustrates when a slit lamp is used and one when it’s not used. “An example of 65220 is a FB on the cornea that can be removed with a Q-tip. An example of 65222 is a FB that will not come out with a Q-tip because it is stuck and needs to be removed by a scoop and picked at for a while before it will move and can be removed.” Consider This Clinical Example For a look at a more detailed FBR encounter, consider this example from Martien: A patient presents to the ED with complaint of pain in the right eye, with tearing and burning. The patient was working in the yard pruning and trimming bushes earlier today. They were not wearing protective eye covering, and they think a piece of grass or other debris flew into their eye. The patient does not use any eye medications, but they had bilateral cataract surgery last year. Examination shows that the patient’s visual acuity is 20/40 in the left eye and 20/20 in the right eye. Intraocular pressures are within normal limits. There is no nystagmus. The right eye is dilated and the slit lamp is brought into position. There is a 2 mm x 2 mm corneal epithelial defect (+fluorescein staining) and a very small object, apparently a grass seed, is seen. There is no corneal stromal infiltrate or thinning. The seed has most likely scraped the cornea, causing a minor abrasion. A moistened cotton swab is used to successfully remove what is, as suspected, a small grass or plant seed. Antibiotic eye drops are prescribed for the patient to use at home over the next seven days. For this claim, you’ll report: Warning: Martien says you should not provide a diagnosis code for corneal abrasion. According to the American College of Ophthalmology, it may cause confusion and result in a claim denial. (https://www.aao.org/practice-management/news-detail/ foreign-body-with-abrasion-noted).
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