Coding and Billing

Treating Ocular Trauma: Do You Know How to Code for It?

By Eric Botts, OD


Knowing how to treat patients with ocular trauma—and how to code and bill for it–expands your optometric services and increases revenue potential.

ROB Bottom Line:
Ocular Trauma

Treating ocular trauma  is an excellent way to increase patient volume and exam revenue. For example, corneal metallic foreign body treatment may generate upwards of $356.38 (WPS Medicare allowables) per patient as the following case study illustrates:
Office Visit
99203/99204/99214/92014 $100.78

Removal of corneal foreign body
with slit lamp          

65222
$73.29
Removal of corneal epithelium
(rust ring removal with algerbrush)  

65435
$77.88
Fitting of contact lens
for treatment of ocular disease 

92071
$36.36
Second Day Office Visit
99213/92012                                                                                                     $68.07
TOTAL: $356.38

If you average one corneal foreign body patient every two weeks, you may generate yearly patient revenue surpassing $9,000–for the initial cost of a forceps and algerbrush. And if you compare this fee to the same service at the local emergency room, your fee is likely up to about 70 percent less.

One of the first business rules of optometry: Be sure to educate your patients on all the services you can provide them–including corneal foreign body removal. Most optometrists treat ocular injuries on a regular basis, and patients appreciate the time and money saved when a visit to the emergency room can be avoided.

Most ocular trauma visits will include one of the following diagnoses:

918.1 Corneal abrasion
930.0 Corneal foreign body
918.2 Conjunctival superficial injury
930.1 Conjunctival foreign body
930.2 Lacrimal system foreign body
360.54 Foreign body, magnetic, in vitreous
360.55 Foreign body, magnetic, in posterior wall
360.64 Foreign body, in vitreous
360.65 Foreign body, in posterior wall
366.20 Traumatic cataract, unspecified
366.21 Traumatic cataract, localized opacities
366.22 Traumatic cataract, total
366.23 Traumatic cataract, partially resolved
802.60 Orbital blowout fracture, closed
802.70 Orbital blowout fracture, open
871.0 Ocular laceration without prolapse or exposure of intraocular tissue
871.1 Ocular laceration with prolapse or exposure of intraocular tissue
873.1 Avulsion of eyeball
921.1 Contusion of eyeball
360.61 Foreign body in anterior chamber
360.62 Foreign body in iris or ciliary body
360.63 Foreign body in lens
365.65 Glaucoma associated with trauma
950.5 Injury to optic nerve and pathways

Procedures performed during a trauma-induced office visit may include one or more of the following:
92002-92014, 99201-99215 Office visit
65205 Removal of foreign body, conjunctival superficial
65210 Removal of foreign body, embedded
65220 Removal of foreign body, corneal, without slit lamp
65222 Removal of foreign body, corneal, with slit lamp
65435 Removal of corneal epithelium
92071 Fitting of contact lens for treatment of ocular disease
92250 Fundus photography
92285 External ocular photography with medical diagnostic evaluation for documentation of medical progress

Match Procedure with Diagnosis Code

Often the most difficult part of coding ocular trauma is knowing what procedures are reimbursed for a particular diagnosis code. The office visit is a good example as it is not always appropriate to include an office visit with every supplementary procedure you perform. Often the chief complaint will dictate whether or not to charge for an office visit. In my practice, if a patient presents complaining of having a foreign body in their eye and can show me where it is in the eye, then an office visit may not be necessary. Instead, I bill only the foreign body removal and any additional procedures performed. However if a patient presents with more vague complaints like eye pain, foreign body sensation or photophobia then an office visit will be performed and billed to determine the cause of the complaint. Note: There is no global period associated with foreign body removal so the next day visit is billable as a separate office visit.

Typically a metallic corneal foreign body removal includes the following:
Initial visit
99203/99204/99214 Office visit
65222 Removal of corneal foreign body with slit lamp
65435 Removal of corneal epithelium (rust ring removal with algerbrush)
92071 Fitting of contact lens for treatment of ocular disease
Second day
99213/92012 Office visit
Coding for a penetrating foreign body injury that involves a foreign body lodged in the anterior or posterior chamber may require 92250 fundus photography to document the location and severity of the embedded intraocular foreign body.
Corneal abrasions and other ocular trauma may include the following:
Initial Visit
99203/99214/99213 Office Visit
92285 External ocular photography with medical diagnostic evaluation
92071 Fitting of contact lens for treatment of ocular disease
Follow-up Visit
99213/92012 Office visit

Most trauma cases require little monetary investment in advanced instrumentation to treat, but reimburse very well.

Let Patients Know About Your Medical Eyecare Services

Marketing flyers in your reception area and copied onto your web site that mention all services you provide including medical eyecare treatment.

Marketing e-blasts also sent via text to patients promoting your medical eyecare services.

Let the local emergency rooms and local family practice doctors know you are able to treat ocular trauma.

Contact all factories, auto shops, machine shops and other businesses at higher risk for ocular injuries and leave the flyers about your services that you created for your reception area and web site. Also be sure to leave a stack of your business cards with your practice name, phone number, e-mail address and web site.

Related ROB Articles

Make Treatment of Ocular Allergies a Profit Center

Code Correctly for External Ocular Infections

Treat for Eye Health–and Code for Profitability

Eric Botts, OD, is founder and president of OBC Billing Specialists, and president of InnovativeEyes, in Macomb, IL. To contact him: drvision@claimdoctor.net.

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