CODING Q&A

Coding Correctly for Eye Trauma Caused by a Foreign Body

ANSWERS PROVIDED BY RIVA LEE ASBELL

Q. A patient sustained trauma to an eye with an intraocular foreign body (nail) in the anterior chamber. He had a full-thickness corneal laceration without uveal prolapse. I removed the foreign body and repaired the corneal laceration. How would you code?

A. This question, sent to me by a retina surgeon, highlights the coding for trauma that sometimes gets performed by the retina surgeon.

Let's take a look at some the general issues and then continue with a couple of clinical examples (below).

When there is potential for a ruptured globe to have occurred, an examination with exploration under general anesthesia is often performed. If there are no problems encountered that require surgical repair, then the only CPT codes available to you are 92018 and 92019.

CLINICAL CASES

CPT codes copyright 2006 American Medical Association.

The CPT definition reads:

"Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of glove for passive range of motion or other manipulation to facilitate diagnostic examination."

Here are some tips for these complicated cases:

► CPT code 92018 is for complete and CPT code 92019 is for limited. The codes are unilateral so each eye is coded separately. There needs to be medical necessity for each side in order to bill that side.

► Often a pars plana vitrectomy is performed with other repairs. Corneal laceration repair codes frequently have a higher allowance than the pars plana vitrectomy so always check that before listing the codes in order of highest paying codes first.

► A foreign body in coding terms is an object that found its way into the body; it is not an implant or device that had been previously placed by the surgeon

► Foreign bodies are either magnetic or nonmagnetic and there are different codes for posterior segment extraction. Code the foreign body by its type; however, the extraction may be different. For example, a magnetic foreign body may be removed by nonmagnetic extraction.

► Have your billers pay attention: the CPT code order for physician coding differs from ASC coding. RP