Optometry Coding & Billing Alert

Question: An established patient who was shooting off fireworks the previous day reports to the office complaining of right eye pain. He says that one of the fireworks exploded “pretty close” to his face, and he has been “scratching at the eye all day.” The optometrist examines the eye area, and notes “undetermined particles and small foreign bodies … could just be ash or paper from fireworks.” The optometrist uses saline to clean out the patient’s eye. Notes indicate the optometrist used no tools other than irrigation for the service. Is this an ocular foreign body removal (FBR), or is irrigation an E/M service?

Oklahoma Subscriber

Answer: This is a superficial conjunctival FBR, and it sounds as if the optometrist also provided an E/M service. On the claim, report 65205 (Removal of foreign body, external eye; conjunctival superficial) for the FBR. Then, report an E/M code based on encounter notes (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient ….).

Remember to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to the E/M code to show that the E/M and FBR were separate services.

Explanation: You can report 65205 when the provider uses irrigation as the sole removal method. Further, it is clear from your description that the optometrist performed a significant, separately identifiable E/M service before deciding to irrigate the eye — so an E/M code is also appropriate for this claim.