Ophthalmology and Optometry Coding Alert

Ophthalmologists often are presented with unusual situations. Billing for these situations is not always straightforward. For example, a woman picks up a bottle of glue, thinking it is her eye drops, and proceeds to pour some glue into her eye before she realizes her mistake. She goes to her ophthalmologist, who has to remove glue from the cornea, as well as some eyelashes which had glue on them. Follow these tips when billing for this procedure:

1. Code with starred procedures. The visit should be coded 65220* (removal of foreign body, external eye; corneal, without slit lamp) if the glue was removed without a slit lamp or 65222* (corneal, with slit lamp) if it was removed with a slit lamp.

2. Bill for an office visit. The starred procedures indicate that you can bill for an office visit as well. You have to charge an office visit, says John S. Bell, chief executive officer of Maine Eye Care Associates, a 15-ophthalmologist practice based in Waterville. The ophthalmologist has to figure out what the problem is, get a history, and get the chief complaint, he says. It would probably be a level two, or maybe a level three if the glue got into the tear duct or something like that.

3. Do not code for epilation. You might think you also could code for epilation. However, the code 67820 (correction of trichiasis; epilation, by forceps only) is specifically for trichiasis. CPT usually does not include the condition in the procedure code, but the fact that epilation codes are only for correction of trichiasis means that you shouldnt use them when the eyelashes are removed because of congealed glue, for example. Most payers will reimburse this code only with a diagnosis of trichiasis. You could try billing it but would probably have to fight for payment, which usually isnt high enough to be worth the time.

4. Refer patient to a cornea specialist. Paul C. Abrantes, RDO, practice administrator for South Coast Eye Care, a five-ophthalmologist practice based in North Dartmouth, Mass., comments further that you should refer the patient to a cornea specialist after the glue has been removed. We would consult with a cornea specialist in our practice to see if any damage was done, says Abrantes. If the glue adhered to the cornea, there could be an abrasion. The general ophthalmologist probably would perform the foreign body removal and the epilation, however.

5. Use the right diagnosis codes. What about diagnosis codes? You could use 930.0 (foreign body on external eye; corneal foreign body), 918.1 (superficial injury of eye and adnexa; cornea), and 930.1 (foreign body on external eye; foreign body in conjunctival sac), depending on where the glue went and what its effects were.