ED Coding and Reimbursement Alert

Corneal may also call for slit lamp use.

A patient reports to the ED with a foreign body in his eye. The ED physician performs foreign body removal (FBR) and the coder chooses the appropriate CPT code for the services. Simple, right?

Not so fast: There are several decisions you must make before deciding what type of eye FBR your physician performed, such as eye area and instrumentation. Then, there are several codes to choose from to pinpoint your FBR claim.

Follow this expert advice on coding all ocular FBRs your ED physician is likely to encounter.

Get to Know 65205-65222

Most ED presentations that end in eye FBRs involve one of the following codes:

• 65205 -- Removal of foreign body, external eye; conjunctival superficial
• 65210 -- ... conjunctival embedded [includes concretions], subconjunctival, or sclera nonperforating
• 65220 -- corneal, without slit lamp
• 65222 -- ... corneal, with slit lamp.

Consider this: "In my experience, we often used a q-tip wet with sterile saline or water to remove a 'floating/superficial' FB," says Linda Martien, CPC, CPC-H, coding specialist at National Healing Inc. in Boca Raton, Fla.

When the physician performs this type of FBR, it is likely a 65205 scenario.

Example: Patient presents with eye irritation after using a weed whacker without eye protection. Exam reveals a small piece of grass superficially embedded in the conjunctiva under the lower lid. The physician is able to remove the foreign body with a saline moistened cotton swab.

In this scenario, you'd likely choose 65205. Instrumentation marks most 65210 encounters In order to remove an embedded FB, the physician will use tools like "tweezers, needle etc.," confirms Anna Martinez, RHIT, coder/analyst at Catholic Health Systems in Buffalo, N.Y.

If the FB was embedded, it was not easily removed by a cotton swab, and the physician would use tweezers, says Martien. An embedded FBR will very often call for a slight incision pre-FBR.

The 65210 code often "refers to embedded FB with incision required. While the incision may penetrate the conjunctiva, it does not penetrate the sclera," says Martinez.

Or, if the patient has an embedded metal FB, the physician might use "a burr to remove rust after an embedded metal FB is removed, and there is some residual rust left from the FB on the conjunctiva," according to Martien.

Corneal FBRs call for 65220, 65222

If the ED physician removes a corneal FBR, then coding choices won't contain the conjunctival removal codes. You'll choose 65220 or 65222 depending on slit lamp use.

Explanation: "The slit lamp is a microscope with a light attached that allows the doctor to examine your eye under high magnification. This instrument is primarily used to view the anterior structures of the eye such as the cornea, iris, and lens," says Martien. Be on the lookout for physician descriptions that match Martien's explanation for slit lamp use evidence.

"Often when a patient is seen with a complaint of an FB in the eye, it isn't readily visible to the examiner. By using the slit lamp, the doctor can be surer that a microscopic FB hasn't been overlooked," Martien explains.

Example: A 23 year old male presents complaining of eye irritation and redness after using a grinder to remove rust from a car he is restoring. He feels like there is something in his right eye. Initial exam reveals irritation but is inconclusive for foreign bodies. A slit lamp exam reveals two small metal fragments embedded in the cornea, which are removed using a beveled needle. Antibiotic drops are prescribed with a warning to use eye protection in the future. In this scenario, you'd likely choose 65222.