CODING Q&A

Posterior Segment Intraocular Foreign Body Removal

Information Provided By Riva Lee Asbell

Removal of posterior segment intraocular foreign bodies by retinal physicians seems to present coding dilemmas for surgeons. It is important to be cognizant of the diagnosis codes as well as the procedure codes and use the correct combination of each. The relevant codes are:

“65235: Removal of foreign body, intraocular, from anterior chamber of eye or lens; (For removal of implanted material from anterior segment, use 65920)
65260: from posterior segment, magnetic extraction, anterior or posterior route
65265: from posterior segment, nonmagnetic extraction. (For removal of implanted material from posterior segment, use 67120)”

Note that there are two codes for removal of implanted material: (1) 67120 Removal of implanted material, posterior segment; extraocular, and (2) 67121 Removal of implanted material, posterior segment; intraocular.

Also, when a code is in dented under another code, all description up to the semicolon is included in the description of the secondary code(s).

IMPLANT REMOVAL OR FOREIGN BODY REMOVAL?

A foreign body, in coding terms, is an object that has entered and is present in the body from some type of trauma, but does not belong there and was not placed by the surgeon. Objects can be synthetic or natural in origin (wood, glass, metal).

An implant, on the other hand, is a manufactured object that has been placed by the surgeon as part of a surgical procedure. When there are complications related to the placement of the implant, its removal is often the procedure of choice.

ICD-9 Codes
871.5: Penetration of eyeball with magnetic foreign body
871.6: Penetration of eyeball with nonmagnetic foreign body
871.7: Nonspecific penetration

Tips:
► Select the diagnosis code that matches the foreign body and not the surgical technique.
► It is possible to have an ICD-9 diagnosis code of magnetic foreign body and a CPT code with a description of nonmagnetic removal.

CASE SCENARIOS

Q. How do I bill the following: intraocular foreign body removal by pars plana vitrectomy (nonmagnetic), focal endolaser used prophylactically for retinal tear repair; pars plana lensectomy; insertion of anterior chamber IOL; internal limiting membrane peeling for concurrent macular hole.
A. The codes are 67042 (Vitrectomy with repair of macular hole) + 65265 (removal of foreign body from posterior segment nonmagnetic extraction + 66984 (Extracapsular cataract removal with insertion of IOL prosthesis…).

Q. Patient had sustained a scleral laceration without uveal prolapse and there was an intraocular foreign body (glass) sticking into the posterior segment (vitreous). Surgery consisted of removal of IOFB (with forceps only), repair of scleral laceration, and injection intravitreal antibiotics. No vitrectomy was done or magnets used, etc.
A. The coding for this would be CPT codes 65265 + 65280 (Repair of laceration; cornea and/or sclera; perforating, not involving uveal tissue).

Q. Patient sustained trauma to the left eye resulting in a corneal laceration with extrusion of uveal tissue and with a metallic foreign body present. Surgery consisted of: (1) Repair of corneal laceration; (2) Lensectomy; (3) Pars plana vitrectomy; (4) Removal of foreign body without magnet; (5) Intravitreal injection of antibiotics.
A. Coding for this would be CPT codes 65265 + 65285 (Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue) + 66850 (Removal of lens material; phacofragmentation technique). The pars plana vitrectomy is bundled. The diagnosis code for this case would be 871.5 even though it was a nonmagnetic extraction. RP

CPT codes copyright 2011 American Medical Association.