ED Coding and Reimbursement Alert

Question: Operative notes indicate that a patient reports to the ED with left eye pain; a small piece of metal hit him in the eye while he was working on a muffler. Our physician examines the affected area, and then uses a burr to scrape the corneal epithelium area clean of the rust ring. How do I report the rust ring removal: Should I report 65430 or 65460 or is this some type of additional foreign body removal (FBR)?

Rhode Island Subscriber

Answer: Both codes are inaccurate for this particular scenario. On the claim, report the following:

" 65435 (Removal of corneal epithelium; with or without chemocauterization [abrasion, curettage]) for the removal

" Modifier LT (Left side) appended to 65435 to indicate which side the physician is working on

" 930.0 (Corneal foreign body) appended to 65435 to represent the patients injury.

Explanation: While the ring itself is a result of the FB, payers do not consider rust ring removal an FBR for coding purposes, and therefore you cannot code 65220- 65222 (Removal of foreign body, external eye &) for this encounter. You should only use 65430 (Scraping of cornea, diagnostic, for smear and/or culture) for diagnostic scrapings, making it inappropriate for this scenario as well.