Ophthalmology and Optometry Coding Alert

Question: How can I report the removal of Crawford tubes? Most tubes stay in for longer than the post-op period, so we should be able to bill for these services. But the code for removal of foreign body from the lacrimal passages (68530) does not seem entirely suitable because a foreign body is defined as any object or substance found in an organ and tissue that does not belong under normal circumstances, and a tube is not there under normal circumstances. Also, is the appropriate diagnosis code 930.2?

Tennessee Subscriber

Answer: The answer may depend on the setting in which your physician removed the tubes. Your ophthalmologist may have to remove tubes from pediatric patients in the operating room under general anesthesia. If this is the case, you may appropriately report 68530 (Removal of foreign body or dacryolith, lacrimal passages) and diagnosis code 930.2 (Foreign body in lacrimal punctum).

Often, however, the physician can remove the tubes in the office. If this is the case, your carrier will likely consider the removal to be part of the E/M service and not a separately billable procedure. Because the global period  for the insertion procedure (68815, Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent) is 10 days, you can separately report E/M services your physician provides in the office following the post-op period.