Optometry Coding & Billing Alert

Success in billing for punctal plug or rust ring removals lies in your choice of codes

Optometrists debate one topic frequently: Are punctal plugs "foreign bodies"? They're certainly not an organic part of the body, and yet they were placed there intentionally by a doctor. So the question becomes whether an optometrist should expect payment for removing a foreign body if he removes punctual plugs - that he inserted - because they are irritating the patient. There is no clear code to use for the removal of permanent punctal plugs. Some Medicare carriers feel that removal of the plugs is included in the original insertion fee regardless of the time frame for removal. They do not think an office visit is even warranted and the plugs should be removed at no charge, if removed by the doctor who inserted them.
 
Tactic: If the removal does not take significant work, you may consider not billing for it at all. But there are some situations in which you're justified in seeking payment, says David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas. "If I had not put the plugs in, then I would charge to remove them," Gibson says.
Bill the work with an unlisted-procedure code, 68899 (Unlisted procedure, lacrimal system), Gibson says. Submit the claim on paper with documentation attached to describe your work, time, risk and supplies used to complete the procedure. Charge accordingly, using the fee for 65205 (Removal of foreign body, external eye; conjunctival superficial).

Extra: An office visit might be justified if you do additional work or spend time after the removal, counseling the patient on other treatment options. If that's the case, make sure to document how much time you spent.

Treat Rust Rings as Foreign Objects

"With metallic foreign bodies of the cornea, you'll usually have to remove a rust ring, too," says Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va. "Keep in mind that this rust ring is a foreign body also." Some doctors code 65222 for FBR and then code for the rust ring removal with 65435 (Removal of corneal epithelium; with or without chemocauterization [abrasion, curettage]), but this is incorrect, Wimbish says.

Example: You remove a metallic foreign body from the right cornea and a rust ring from the right eye. Report  99212-25 (Office or other outpatient visit for the evaluation and management of an established patient; significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) linked to ICD-9 code 379.91 (Pain in or around eye), and report 65222-RT (Removal of foreign body, external eye; corneal, with slit lamp) linked to 930.0 (Corneal foreign body), Wimbish says.

But what if the metallic foreign body is gone by the time the patient gets to your clinic, and the only thing to remove is the rust ring? How should you code that? "Just like you would if the metallic FB was still there," Wimbish says. "Remember that the rust ring is a foreign body - to the cornea."