Ophthalmology and Optometry Coding Alert

The "You Be the Coder" challenge in Ophthalmology Coding Alert Volume 12, Number 1, recommended reporting code 65435 (Removal of corneal epithelium; with or without chemocauterization [abrasion, curettage]) for rust ring removal using a slit lamp and a burr. But that code may not accurately describe the work being done, explains David K. Emmel, MD, an ophthalmologist in Wethersfield, Conn.

"I have been removing corneal rust rings for 25 years and I can tell you that apart from the occasional accident, I have never removed corneal epithelium to do this," Emmel says. "The rust is embedded in the Bowman's membrane and often in the underlying stroma, but is never in the epithelium; in fact, there is virtually always an epithelial defect overlying the rust ring."

The procedure: Emmel removes rust rings with a hypodermic needle that cuts under and around the rust to loosen it so he can remove it in once piece with forceps. He then uses a burr to remove any remaining rust containing stromal debris.

Because removal of epithelium is not part of his work, 65435 would not be the best description of the procedure, he says. "My procedure for removing rust rings is much closer to digging out a solid foreign body shallowly embedded under the epithelium."

Best way: Emmel's recommendation? Code 65222 (Removal of foreign body, external eye; corneal, with slit lamp). "That is the code I have been using, with success, all these years."

Report 65435 for removal of corneal epithelium to facilitate healing of a corneal abrasion or a herpetic geographic ulcer, Emmel advises. "That procedure is literally 'the removal of corneal epithelium,'" he says.