Ophthalmology and Optometry Coding Alert

Question: A patient with glass in her cornea came into our office. The ophthalmologist removed the glass and repaired the cut. How should I code this procedure?


California Subscriber


Answer: Because the ophthalmologist had to repair a laceration after removing a corneal foreign body (FB), you should report 65275 (Repair of laceration; cornea, nonperforating, with or without removal foreign body).

Key: Note that the code definition includes "with or without removal foreign body." This prevents you from reporting the FB removal separate from 65275, even in the absence of a National Correct Coding Initiative bundle.
 
Watch out: You might be tempted to use 65235 (Removal of foreign body, intraocular; from anterior chamber of eye or lens) and 65260 (... from posterior segment, magnetic extraction, anterior or posterior route), but remember that these are "facility-only" codes, usually performed in an operating room setting, such as a hospital or ambulatory surgical center, not in the ophthalmologist's office.

Catch: CPT recognizes treatment of traumatic eye injuries in the office, often done on an emergency basis by the ophthalmologist by including 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) to reflect the additional time and skill needed. The trouble is that Medicare and many other carriers don't pay on 99058. Medicare doesn't even assign relative value units (RVUs) to the code.

Bright side: Some third-party insurers may reimburse for the emergency and after-hours codes--you'll never know unless you submit the claim. Further, omitting the code means you are not accurately reporting the patient's visit. To help justify reporting 99058, encourage your ophthalmologist to include the specifics of the emergency interruption in the medical record documentation of the patient's encounter.