This article looks at three ophthalmology medical coding myths that could be causing coding errors and affecting payments.

Be Careful When You Code FBRs

First Myth – All Foreign Body Removals (FBRs) within a single eye are clubbed together, which means an FBR code can only be coded once per eye.

The Actuality – It is true that a coder cannot separately report removal of many foreign bodies from the same region of the eye. However, if the ophthalmologist has removed foreign bodies from different regions of the same eye (such as the conjunctiva and cornea) codes can be separately reported for each region. The ophthalmologist should draw a comprehensive figure of the eye that makes clear the specific region and depth of the removed FBRs. If the ophthalmologist has taken out an embedded conjunctival foreign body, you can report a code in 65210 which offers higher reimbursement. This is good news for both coder and physician.

Second Myth – A foreign body diagnosis can be coded even if the examination doesn’t reveal a foreign body.

The Actuality – It is not correct to report a foreign body ICD-9 code (930.0-930.9, Foreign body on external eye) when a foreign body has not come up in the ophthalmologist’s exam. However, coding can be done for the sensation of a foreign body, with an eye pain code (for example 379.91).

Third Myth – The kind of instrument the ophthalmologist uses establishes which FBR code to report.

The Actuality – The FBR series of codes (65205 to 65222) make no mention of a specific instrument to take out the FB. Nevertheless, CPT® code 65222 (Removal of foreign body, external eye; corneal, with slit lamp) does point out the equipment utilized to make viewing the affected area easier. If the ophthalmologist made use of a slit lamp to see the corneal foreign body, the code to be used is 65222. If he didn’t use a slit lamp, the code is 65220.

Outsource to Minimize Errors

To ensure that your medical coding process is not affected by myths or errors that can even cause claim denials, it is best to outsource this process to experts. Do research to find an HIPAA compliant outsourcing company with a good reputation, a superior track record and an extensive client base.

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Julie Clements

Chief Solution Manager at Managed Outsource Solutions
Joined the MOS team in March of 2008. Julie Clements has background in the healthcare staffing arena; as well as 6 years as Director of Sales and Marketing at a 4 star resort. Julie was instrumental in the creation of the medical record review division (and new web site); and has especially grown this division along with data conversion of all kinds.