Tuesday, 31 January 2012

65205-65222 Coding Success Hinge on Location, Penetration Level

Documented set in corneal FBRs can earn $10 more per procedure.

Are you regularly selecting your foreign-body removal (FBR) code based on what instrument the ophthalmologist used? You might be reporting the wrong CPT code – which results collecting the wrong payments. Get the fact behind this and other FBR myths that consistently trip up your ophthalmology medical coding colleagues.

Myth #1: The sort of instrument the ophthalmologist uses defines what foreign-body removal code to report.

Reality: The CPT codes in the FBR code series (65205-65222) do not specify any exact instrument for removing the FB. Though, CPT code 65222 (Removal of foreign body, external eye; corneal, with slit lamp) does specify the equipment used to improve viewing of the affected area. You must select a code according to the specific location and level of penetration of the FB in the eye.

For instance, for the removal of a superficially penetrating FB in the conjunctiva, you would report 65205 (Removal of foreign body, external eye; conjunctival superficial). On superficial conjunctival FBRs, the ophthalmologist will normally use one of the following listed methods, or a combination of the three:

  • irrigation

  • a cotton swab

  • the tip of a beveled needle.

  • This does not influence your code choice, however.

    Not so fast: In case the ophthalmologist carries out an FBR in the cornea, you will be required to consider whether he uses a slit lamp to visualize the FB. Report CPT code 65220 (Removal of foreign body, external eye; corneal, without slit lamp) in case he did not use the slit lamp; otherwise, report 65222 (... corneal, with slit lamp).

    Myth #2: All FBRs in the same eye are bundled, which means you can simply bill a FBR code once per eye.

    Reality: This is true in case the ophthalmologist removes multiple foreign bodies only from the same part of the eye. In case he removes FBs from different parts of the same eye -- the cornea as well as the conjunctiva, for instance -- you can distinctly report a code for each location.

    Documentation is crucial here, say experts, and the physician must draw a detailed diagram of the eye showing the exact location and depth of the foreign body(ies) removed.

    In the Correct Coding Initiative, the CPT codes relating to FBs in the conjunctiva, 65205 and 65210 (… conjunctival embedded [includes concretions], subconjunctival, or scleral nonperforating), are not bundled with corneal FB codes 65220 and 65222, which implies that you are allowed to report both codes -- 65210 and 65222, for example -- separately.

    Good news: You can certainly report a higher-paying code in 65210 in case the ophthalmologist removes an embedded conjunctival FBR. In 2012, code 65210 has 2.01 total RVUs. Multiplying this by the 2012 conversion factor (24.6712) produces $49.59 in reimbursement. On the other hand, code 65205 has only 1.61 total RVUs -- leading to a reimbursement total of $39.72.

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