Question: A patient reported with a foreign-body sensation after mowing the lawn and doing other yard work. Using a slit lamp, the ophthalmologist removed a superficial conjunctival FB and a corneal FB from a patient’s right eye; evidence of slit lamp use is in the notes. How should I code this?
Alabama Subscriber
Answer: Report CPT® code 65222 (Removal of foreign body, external eye; corneal, with slit lamp) for the removal of the corneal foreign body using the slit lamp. Report CPT® code 65205 (Removal of foreign body, external eye; conjunctival superficial) for the conjunctival FB.
Dx: Report ICD-9 code 930.0 (Corneal foreign body) connected to CPT® 65222 for the corneal foreign body. After Oct. 1, 2015, you would report the appropriate ICD-10 code, depending on which eye was affected:
For the conjunctival FB connected to CPT® 65205, report ICD-9 code 930.1 (Foreign body in conjunctival sac); after Oct. 1, 2015, report one of these ICD-10 codes:
Room to grow: For both of the above ICD-10 code series, the sixth character “X” is a placeholder that allows for future expansion of the diagnosis code series. The final digit, “A,” assumes that this is the patient’s initial encounter for a foreign body. For a subsequent encounter, replace “A” with “D”; for sequela, use “S” as the seventh character.