ED Coding and Reimbursement Alert

Youll sell ED short if you cannot recognize slit lamp use.

Coders skilled at eyeing opportunities to choose a slit lamp code for corneal foreign body removal (FBR) are a good asset, netting their EDs $13 more for the same service. Gaze down the path to wisdom with this expert advice on how to code your physicians ocular FBRs.

Code Superficially for FBR by Washout

The area of the eye matters on your ocular FBR services. For FBRs from the conjunctiva, 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.

On superficial conjunctival FBRs, Joshua Tepperberg, CPC, EMT-D, reports that the ED physician will typically use one of the following methods, or a combination of the three:

" irrigation

" a cotton swab

" the tip of a beveled needle.

Example: A patient reports to the ED complaining of left eye pain; he reports that he was at a construction site and exposed to lots of sawdust without any eye protection. The ED physician identifies a wood shaving on the patients conjunctiva, which he removes with saline irrigation and a Q-tip.

In this scenario, report 65205 for the service with 930.1 (Foreign body in conjunctival sac) appended to represent the FB.

Embedded FBs Mean Physician Must Perform 65210

Good news: Notch a higher-paying code in 65210 if the physician removes an embedded conjunctival FBR.

Bad news: No exact definition of embedded conjunctival FBR exists, says David Gibson, OD, a practicing optometrist in Texas.

Generally, the main difference between these two procedures is that the 65210 often requires a small incision into the conjunctiva, but not as deep as the sclera, relays Tepperberg, coding team leader at Caduceus Inc. in New York City.

Most of your EDs conjunctival eye FBRs will be superficial, says Gibson, who offers this advice: If part of the surface is exposed and you can get to it easily, then its superficial. If you have to open tissue to get to the FB, then its embedded.

Slit Lamp Equals $13 More on Corneal FBRs

If a patient has an FB embedded in his cornea, the ED physician may or may not use a slit lamp during the procedure.

The physician uses a slit lamp when she needs to visualize the structure of the eye in order to perform the removal, explains Tepperberg. A slit lamp is basically used to shed light on the situation, he says.

When the physician performs corneal FBR without slit lamp, report 65220 (& corneal, without slit lamp); for slit lamp FBRs, opt for 65222 (& corneal, with slit lamp), says Gibson.

Payout: The 65220 code pays about $38 (1.05 transitional facility relative value units times Medicares 2009 conversion rate of 36.0666), while 65222 is worth about $51 (1.40 RVUs times 36.0666).

Check Modifier Rules on Multi-FBRs

You can report conjunctival or corneal FBR only once per eye per encounter, no matter how many FBRs the physician removes, Gibson confirms.

Example: The ED physician removes three paint chips resting superficially on the conjunctiva of a patients right eye; report 65205 for this encounter.

If the physician removes FBs from different anatomical parts of the same eye, however, then you can report a pair of codes, says Judy Newberry, LPN, CPC, CCS-P, director of coding for Insurance Data Services Inc. in Wyoming, Mich.

Example: The ED physician removes a superficial conjunctival FB and a corneal FB from a patients right eye; evidence of slit lamp use is in the notes. On the claim, you would report the following:

" 65222 for the slit lamp removal with 930.0 (Corneal foreign body) appended to represent the FB

" 65205 for the conjunctival removal with 930.1 appended to represent the FB.

Note: The payer might want you to append modifier 51 (Multiple procedures) to 65205 to show that the physician performed two different FBRs. Check with a rep before filing if you are unsure.