Ophthalmology and Optometry Coding Alert
Pinpoint Proper Reporting for This FBR Encounter
Question: A welder presents with swelling in his left eye. The ophthalmologist finds metal flakes over the patient’s conjunctiva/conjunctival sac and cornea, though none of it is embedded. The doctor removes two conjunctival flakes with tweezers, then uses a slit lamp and needle to remove a flake from the cornea. How is this reported? Should I use one or two codes for the removal, and do I need to include a modifier? AAPC Forum Participant Answer: In the event that a patient requires removal of both a conjunctival and corneal foreign body (FB) from the same eye, choose codes for each service and report both on the claim. However, don’t be surprised if the payment is reduced for one of the removals. You would code the corneal foreign body removal (FBR) and the conjunctival FBR as normal, but you will probably get a multiple surgery reduction of fees, depending on the payer. You should bill each code for the full amount and let the payer reduce them if it wants. Note that use of modifier 51 (Multiple procedures) might speed up the claims process with certain insurers. Best bet: Some payers might want to see modifier 51 on claims in which the ophthalmologist removes FBs from different sections of the same eye; others will just make the multiple surgery reduction when they receive a claim with two procedure codes, even when modifier 51 is not reported. If you are unsure of the payer’s policies on this issue, check your contract before coding. On the claim, you should report the following: Be sure to append modifier 51 to 65205 to represent the separate nature of the FBRs — if your payer requires it.
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