Optometry Coding & Billing Alert

Know the Ins and Outs of Foreign-Body Removal

- Published on Sun, Dec 26, 2004
" Follow our expert advice and translate FBR coding and billing questions into reimbursement Foreign-body removals (FBR) are some of the most common procedures optom- etrists perform. Yet confusion persists about proper billing and coding under different circumstances such as multiple foreign bodies in one eye or an exam performed with an FBR - confusion that could be costing you as much as $200 per visit.

Use our expert answers to these frequently asked questions about FBR to keep you on the path to coding and billing success. What are the CPT codes for foreign-body removal? Optometrists generally limit their foreign-body removals to the external eye and eyelids, says Heather Kingery, insurance supervisor for the Pontiac Eye Clinic in Farmington Hills, Mich. Use these codes to report the procedures:

    65205 - Removal of foreign body, external eye; conjunctival superficial

    65220 - ... corneal, without slit lamp

    65222 - ... corneal, with slit lamp

    67938 - Removal of embedded foreign body, eyelid. Can I bill an E/M code along with the removal code? Unless you find it necessary to do a history, exam and decision-making with the performance of the FBR, you should not code for and bill the office visit, says David Gibson, OD, FAAO, a practicing optometrist in Lubbock, Texas. But if you think the patient requires a full workup to rule out other problems and you consider this to be medically necessary, you should code and bill both services.

Whether or not to bill an E/M code depends on what the patient tells you, Gibson says. If the patient says" 'My eye hurts ' then an office visit is needed to determine why " he says. Document the exact complaint the patient has if you want to defend using an office visit and an FBR procedure together Gibson says.

You may not get reimbursed for both services however if you don't follow the documentation modifier and diagnosis coding requirements for reporting an E/M service and a foreign-body removal on the same day.

Trap: If you document the FBR in the slit lamp portion of the examination the carrier may assume that the office visit service was an integral part of the minor procedure and therefore included in the payment for the procedure.

Solution: Be sure to document the history exam and decision-making components of the E/M service in a separate dated entry for the FBR. Choose an appropriate examination code depending on the documentation and append modifier -25 (Significant separately identifiable evaluation [...]

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