Pediatric Coding Alert

Question: A patient reported to the pediatrician with a conjunctival foreign body in her right eye. The provider removed a small amount of dirt using irrigation with saline solution and a cotton swab. I reported 65210 and received a denial. How should I resubmit the claim?

Rhode Island Subscriber

Answer: From the encounter you describe, it sounds as if you should have reported a superficial foreign body removal (FBR). When you resubmit the claim, report 65205 (Removal of foreign body, external eye; conjunctival superficial) for the FBR with modifier RT (Right side) appended to represent laterality — if the insurer requires the LT/RT modifiers. Also, append T15.11 (Foreign body in conjunctival sac, right eye) to 65205 to represent the patient’s FB.

Why the denial? For conjunctival FBRs, coders choose from 65205 or 65210 (… conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating) depending on the location and penetration of the wound. You should report 65205 when the provider removes a superficial FB with “minimal” means; these minimal means include irrigation and cotton swab/forceps use, which is why your 65210 claim met with resistance.

In order to properly report 65210, the FB might penetrate the conjunctiva, but it would not penetrate the sclera. When the provider performs 65210 for a conjunctival FBR, he might also use a slit lamp.

Remember: Coding conjunctival FBRs can be very tricky; if there’s any doubt as to the level of FB removal, consult with the provider and get more information so you can make the most informed decision possible.