Ophthalmology and Optometry Coding Alert

Question: A patient came in after having put glue in her eye because she mistook the small bottle for her eye drops. The ophthal­mologist had to remove the glue from the cornea, as well as some eyelashes that had glue in them. Which codes apply to this situation?

New Hampshire Subscriber

Answer: The answer will depend on what details are included in the documentation, but you’ll likely start with the foreign body removal codes, since the glue is a foreign body.

If the glue was removed without a slit lamp, you’ll likely report 65220 (Removal of foreign body, external eye; corneal, without slit lamp). If the physician did use a slit lamp, the most appropriate choice would probably be 65222 (Removal of foreign body, external eye; corneal, with slit lamp).

If the documentation supports it, you’ll also bill for an office visit (99202-99215). This is because the ophthalmologist has to figure out what the problem is, create a diagnosis, and determine the best course of action. You’ll append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the office visit code to demonstrate that it was a separately identifiable service from the foreign body removal.

You might think you also could code for epilation for the eyelash removal, but the code 67820 (Correction of trichiasis; epilation, by forceps only) is specifically for trichiasis. Therefore, you shouldn’t use this code when removing eyelashes because of congealed glue, for example. Most payers will reimburse this code only with a diagnosis of trichiasis.