Angela I Posted Wed 25th of September, 2019 10:12:29 AM
While treating a patient with an alkali burn, our office irrigated the eye every 30 minutes for 12 hours. What is the proper cpt code to use for this? In the past, we've used 99070 and have been told we can only bill one unit per hour. Is this correct? If not, what would be the correct way to do this.
SuperCoder Answered Thu 26th of September, 2019 06:06:14 AM
Irrigation is basically performed for removal of foreign body. CPT 65205 (Removal of foreign body, external eye; conjunctival superficial). In this procedure, when the patient is appropriately prepped and the area anesthetized, the provider irrigates the eye with sterile solution to dislodge and remove a foreign body. If necessary, he uses a cotton swab dipped in sterile saline and moves it across the conjunctiva in a gentle swirling motion to remove the foreign body. As per Medicare, MUE for this code is "1", means only one can be billed for this code for same date of service. However, MUE MAI indicator for the code 65205 is "3", which indicates a date of service (DOS) edit based on clinical benchmarks. Payers who apply the MUE sum the code's same-DOS units. If the sum exceeds the MUE value, the payer will deny same-DOS lines with that code on the current claim. MACs may pay excess units upon appeal or may bypass the MUE based on documentation of medical necessity.
You may be able to include an evaluation and management, or EM service, in some cases. For example, the provider examines a patient experiencing eye irritation after exposure to foreign body (chemical). He looks for foreign bodies and then may perform an irrigation of the eye even though definitive foreign body particles are not identified. This constitutes a superficial conjunctival foreign body removal but also an evaluation and management, or EM service. Report 65205 for the foreign body removal and select the appropriate EM code and use modifier 25.
On the other hand, CPT 99070 is for Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided). In this code Then provider examines and treats the patient utilizing excess supplies or materials or providing additional materials to the patient beyond what would normally be utilized or provided. This does not seem appropriate for irrigation of eye.
In your case, for the service(s) provided on an emergency basis in the office, you can check for the CPT 99058 (Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service). Report this code in addition to the appropriate evaluation and management, or E/M, code that describes the services rendered. Two key words to remember when considering 99058 are emergency and interruption. If the patient arrives unexpectedly, has an emergency need, and other schedules are changed to accommodate the patient, the visit qualifies for 99058. If you had an opening in your schedule and other appointments were not impacted, do not report 99058. Verify that the provider includes adequate documentation in the patient record supporting 99058. Payers want to know that the provider treated the patient for an emergent problem and fit the patient into the schedule because of that problem. A walk-in patient does not automatically qualify for 99058. The patient must have an acute, or sudden and urgent, problem that demands assessment and treatment.
Hope this helps!