Dr. Davis (right as you look at photo) and a high school friend, who were on vacation with their wives. Dr. Davis says many fun summer activities can result in less-than-fun eye injuries, which ODs need to know how to code for correctly.
Coding for summer eye mishaps.
By Mark K. Davis, OD
July 17, 2024
In my almost 40 years of practice, I have come across several unusual ocular situations. You too may have seen, or will soon see, the summertime eye emergencies I highlight in this article. Let’s look at how to code and bill for each of these situations.
Beach Volleyball
Whether it’s a family member’s or friend’s fun game, or NCAA competition, anytime sand is involved there is a very good chance that a corneal abrasion will happen.
In the case of one of my patients, luckily only one eye was involved, the right eye. The patient immediately rinsed their eye with water, but they still complained of a foreign body sensation and sought care from our office (fortunately, not the local urgent care center). This is why I gave my card with my cell number to all my patients. It was never abused, and my patients really appreciated it.
Initial encounter:
Dx: S05.01XA – injury of conjunctiva and corneal abrasion without foreign body, right eye, initial encounter
Tx: Your choice on the office visit code: 92002 (new) or 92012 (est.) or 99202 (new) 0r 99213 (est.)
92285 – external ocular photography
92071 – RT bandage contact lens
Follow up visit:
Dx: S05.01XD – injury of conjunctiva and corneal abrasion without foreign body, right eye, subsequent encounter
Tx: 92012 (est.) or 99212 (est.)
92285 external ocular photography
92071- RT (if needed again)
Fishhook
I’m an avid fisherman, both fresh water and salt water. I had many a fishhook through my hand and fingers, but luckily never through any part of my eye. I treated fishhooks in the eyelid.
If the hook is all the way through the skin, just cut the barb off and pull the body of the hook back out. This is the best situation.
If it is partially embedded, you have two options. Either push it through to expose the barb or pull it back out. Both are more painful, and you may need to use an injectable anesthetic (Lidocaine HCl 2% with epinephrine), if your state law allows you to use.
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Also make sure the patient had a tetanus vaccination within the last 10 years. If not, then send them to the urgent care center. Prescribe an oral antibiotic for 7-10 days. RTC PRN.
Dx: H02.811 – retained foreign body in right upper eyelid.
Tx: No office allowed, as you already know what foreign body is present.
92285 external ocular photography
67938 – E1 (Upper Left, Eyelid) or E2 (Lower Left, Eyelid) or E3 (Upper Right, Eyelid) or E4 (Lower Right, Eyelid)
Insect Wing
One of my patients was riding his motorcycle without goggles or sunglasses. He did have a helmet on, thank goodness. He was hit in the eye by a bug (at 60 miles an hour!). He presented at the emergency room with eye pain and blurred vision. He was treated with oral analgesics and antibiotic drops. He was instructed to see an eye doctor if pain or blurred vision persisted.
The patient presented with the complaint of a continued foreign body sensation in the traumatized eye two weeks after the initial incident. The pain subsided, and he finished his drops. A slit lamp examination with NaFl revealed foreign body tracks on the affected eye. I everted the eyelid and found an insect wing! True story!
Dx: T15.12XA – foreign body in conjunctival sac, left eye, initial encounter.
Tx: 99213 (est.) – 25; an office visit was allowed because there was not an obvious cause for the foreign body sensation and I had to “hunt” for it.
As you will recall, the 25 modifier is defined as a significant, separately identified evaluation (E/M) service by the same physician on the same day of the procedure or other service.
92285 external ocular photography
65205 –E1 removal of foreign body from external eye, specifically in conjunctiva
Thorn In The Eye
The teenage patient was riding a four-wheeler out on dusty, mesquite covered trails in West Texas with a helmet, but again without sunglasses, safety glasses or goggles!
A mesquite thorn hit him in the right eye, piercing the cornea at 5:00, mid-periphery. He presented to my office with pain and reduced vision. The slit lamp examination showed a positive Seidel sign.
Dx: S05.31XA- ocular laceration without prolapse or loss of intraocular tissue, initial encounter
Tx: 92285 external ocular photography
65286 repair of lacerations in the cornea and/or sclera using tissue glue (cyanoacrylate – superglue)
92071 – RT bandage contact lens (if needed for superficial abrasions)
Follow up visit:
Dx: S05.31XD – ocular laceration without prolapse or loss of intraocular tissue, subsequent encounter
Tx: 92012 (est.) or 99213 (est.)
92285 external ocular photography – only if there is an abnormality (still some SPK or staining or positive Seidel sign, hopefully not).
You must have an irregularity to take a photo. You are not supposed to take a photo of a normal cornea and receive payment. This will be taken back upon an audit.
I’m sure these situations are not unique to Texas, but maybe we have a few more rowdy individuals.
I hope these examples have been helpful. Have a happy and safe summer. Until next time, Happy Coding!
Mark K. Davis, OD, is a Therapeutic Optometrist and Optometric Glaucoma Specialist, Diplomate, American Board of Optometry, Adjunct Assistant Professor, University of Houston College of Optometry and Chief of Optometry, 147th Medical Group. He is Lt Col, Texas Air National Guard, Ellington Field JRB, Houston, Texas. To contact him: mkdavisod@gmail.com
