Pediatric Coding Alert

Question: Our pediatrician performed a fluorescein staining for detecting a corneal abrasion. When he performed this in the emergency department (ED), he says he used a specific code. Has CPT introduced a fluorescein code? If not, should I use 92012?Georgia Subscriber

Answer: Your pediatrician may be thinking of 92230 (Fluorescein angioscopy with interpretation and report). But this code requires an angioscopy, which involves injecting the fluorescein (an orange dye) into the arm. Although he may have performed this service in the ED, your office probably doesn't have the supply and equipment necessary for this complicated procedure.

CPT has no specific code for dipping a strip into the eye. You should instead include the fluorescein stain in the E/M service (such as 99201-99215, Office or other outpatient visit). If you had to interrupt the schedule to treat a patient with acute eye pain, you may want to add on special services in-office emergency code 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service).

Beware: Although CPT does not limit codes to specific physicians, ophthalmological services (92002-92014) are intended for ophthalmologists. Insurers may not cover pediatricians' use of these codes. Plus, their descriptions, such as 92012's "ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic treatment program; intermediate, established patient" may go beyond the services your pediatrician provides.

-- Answers to You Be the Coder and Reader Questions provided/reviewed by Deborah Grider, CPC, CPC-H, CPC-P, CCS-P, EMS, RMA, president of the American Academy of Professional Coders' National Advisory Board in Salt Lake City; Jeffrey F. Linzer Sr., MD, MICP, FAAP, FACEP, associate medical director of compliance and business affairs for the division of pediatric emergency medicine department of pediatrics at Children's Healthcare of Atlanta at Egleston; and Richard H. Tuck, MD, FAAP.