Ophthalmology and Optometry Coding Alert

FB removal coding depends on the site--and sometimes on the whims of the carrier

If a patient has multiple foreign bodies in the eye, can you code each one separately? The answer, coding experts say, depends on the specific scenario. Scenario 1: Multiple FBs in Right Cornea If a patient has multiple foreign bodies in the same site in the same eye ...quot; for instance, the conjunctiva or the cornea--you can only report one procedure, no matter how many FBs you remove. For foreign bodies in the cornea, report one unit of 65220 (Removal of foreign body, external eye; corneal, without slit lamp) or 65222 (... corneal, with slit lamp), depending on whether or not you used a slit lamp to remove the foreign bodies. Append modifier RT to indicate which eye was treated. Scenario 2: FBs in Right Conjunctiva and Right Cornea In the National Correct Coding Initiative, the codes concerning FBs in the conjunctiva, 65205 (Removal of foreign body, external eye; conjunctival superficial) and 65210 (... conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating), are not bundled with corneal FB codes 65220 and 65222, says Raequell Duran, CPC, president of Practice Solutions in Santa Barbara, Calif. This means you are free to report both codes--65210 and 65222, for example--separately.

Tip: "I definitely would send along documentation," clarifying that the FBs were in different parts of the eye, says Deena Happel, CPC, CCS-P, CMA, coder and accounts manager for Lifetime Eyecare in Geneseo, Ill.

But insurers don't always see it that way--some will pay for only one removal procedure. Your strategy? Code the one that has the highest fee--in this case, the corneal FB removal (65222-RT). Scenario 3: FBs in Both Corneas If you remove foreign bodies from the right cornea and the left cornea, code both removals--report 65222-RT and 65222-LT or 65222-50 (Bilateral procedure).

Medicare payers will reimburse 150 percent of the fee schedule amount for 65222 performed bilaterally. Based on the 2006 fee schedule, 65222 performed unilaterally should reimburse $70.49 (before geographic adjustments are factored in). Claiming 65222-50 should yield $105.73. Scenario 4: FBs in Right Cornea and Left Conjunctiva Since the FBs are in different eyes, you can report one unit of 65205-LT or 65210-LT along with one unit of 65220-RT or 65222-RT. Your practice should earn the full amount for both codes.