Practice Management Alert

Question: I was helping out with coding recently, doing the best I could to code an ocular foreign body removal (FBR). I had trouble with the different types of ocular FBRs. Could you explain the different types of FBRs our providers might perform on a patient’s eyes?

Indiana Subscriber

Answer: There are two types of FBRs commonly performed in medical offices: conjunctival/subconjunctival and corneal.

Conjunctival FBR rundown: If the provider performs conjunctival/ subconjunctival FBR, you should report 65205 (Removal of foreign body, external eye; conjunctival superficial) or 65210 (… conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating). The code you choose will depend on the location and penetration of the wound.

During a 65205 encounter, the provider might remove the FB with tweezers, a burr, a needle, or even a wet cotton swab. If you see evidence of one of these tools on the encounter form, it could be a 65205 encounter. If the FB is embedded and there is evidence of an incision, you would opt for 65210.

Corneal FBR rundown: If the provider removes a corneal FBR, you’d code the service with either 65220 (… corneal, without slit lamp) or 65222 (… corneal, with slit lamp). The code you choose for corneal FBR depends on whether or not the provider used a slit lamp during the procedure. A slit lamp is a microscope that magnifies a patient’s eye, thereby making FB identification and removal safer and easier.  Most providers use the lamp when viewing the cornea, iris, or lens. If you see evidence of slit lamp use on the encounter form, it could be a corneal FBR.

Caveat: These are merely guidelines, and there are always potential exceptions to them; for example, some 65210 encounters involve slit lamp use. If you are unsure about how to code an ocular FBR, consult with a coder before signing off on the claim.