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Ophthalmology and Optometry Coding Alert

Reader Questions:

Use Patient Complaint for FBR Coding

Published on Thu Mar 04, 2010

Question: The ophthalmologist saw a patient yesterday who had a conjunctival foreign body. I billed 65205 and 92012. Then I saw an article that said I couldn't bill for both an office visit and the procedure on the same day. Is that true? Minnesota Subscriber Answer: Unless the ophthalmologist does a complete workup (history, exam and decision-making) prior to or following the performance of the FBR, you should not code and bill an E/M service or eye code (92012, Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient) along with the foreign-body removal (65205, Removal of foreign body, external eye; conjunctival superficial). But if the ophthalmologist determines it is medically necessary for a full workup due to other problems or as a necessary adjunct to perform the FBR procedure, you should code and bill both services. Append modifier 25 (Significant, separately [...]
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