Outpatient Facility Coding Alert

Understand when – and when not – to report 65435.

Removing a foreign corneal body or rust ring may be a common procedure at your clinic, but getting the code right can be a challenge due to the procedures involved. Keep these tips in mind to stay on the right track.

Stay Away from 65435 With FBR

If your ophthalmologist removed a rust ring and epithelial tissue from a patient’s central cornea using a slit lamp and a burr, report code 65435 (Removal of corneal epithelium; with or without chemocauterization [abrasion, curettage]) as it describes the procedure most accurately.

Nonetheless, be aware that 65435 cannot be reported for removal of a cornea rust ring when a foreign body is found or removed. Instead, you will have to report the service using either 65220 (Removal of foreign body, external eye; corneal, without slit lamp) or 65222 (… corneal, with slit lamp) as appropriate.

Heads Up for 65222

Check with your payer to verify its preference for reporting bilateral procedures: with modifier 50 (Bilateral procedure) or with both modifiers RT (Right side) and LT (Left side). If only one eye is treated, append RT or LT to indicate which. Remember also to use the appropriate modifier when more than one foreign body is removed.

Unfortunately, there are no CPT^® codes that represent the extra work needed to remove multiple foreign bodies. You’ll stick with 65222. Nevertheless, if you are submitting a claim for an E/M service on the same day as the foreign body removal, you need to add 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 office visit code to get paid for the services.

Plus: Because 65222 does not have a global post-op period, it is appropriate to bill an E/M code for related follow-up visits. 

Know When to Avoid 65222 With 65435

The removal of rust ring on the same day as the corneal foreign body removal is considered an inclusive component of the procedure. Therefore, you do not report 65435 in addition to code 65222.

Be aware: Some experts say that 65435 may not accurately describe the work being done because the surgeon usually does not need to remove corneal epithelium in order to remove corneal rust rings. The rust is embedded in the Bowman’s membrane and often in the underlying stroma, but is not in the epithelium. These coders recommend that you report 65222 (Removal of foreign body, external eye; corneal, with slit lamp) for epithelium removal instead of 65435.

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