Insurance billing question...

[planex]

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Is it okay [legal/ethical] to bill insurance for foreign body removal when removing punctal plugs from a symptomatic patient? (if they are causing epiphora or FBS etc.)😕

 

[Richard_Hom]

Is it okay [legal/ethical] to bill insurance for foreign body removal when removing punctal plugs from a symptomatic patient? (if they are causing epiphora or FBS etc.)😕

Dear planex,

First, a foreign body usually means something that got there by accident. This was by design. Second,why not code for grunulation of the puncta instead?

 

[PBEA]

thats iffy, although I regularly code FB when I remove a CL that a pt has either torn, or "lost" in their eye. If you just installed the PPlug, then I believe there is a global period for complications, if your past the global period, then I agree with drhom, code other diag.

 

[posner]

Dear planex,

First, a foreign body usually means something that got there by accident. This was by design. Second,why not code for grunulation of the puncta instead?

The removal of a foreign body is a specific procedure code 65222 or 65210(depending on whether it is corneal or conj). Did yo mean you thought he shuld play it safe and bill with E/M codes appropriate for the visit(history, exam, decision) and bill with ICD-9 code for granulation of puncta?

posner

 

[Richard_Hom]

The removal of a foreign body is a specific procedure code 65222 or 65210(depending on whether it is corneal or conj). Did yo mean you thought he shuld play it safe and bill with E/M codes appropriate for the visit(history, exam, decision) and bill with ICD-9 code for granulation of puncta?

posner

I guess I would code conservatively only because in good consciousness, the foreign body wasn't by accident. Let's suppose the patient came from another doctor. The appropriate diagnosis isn't foreign body but granulation or even nasolacrimal duct obstruction. Code for those problems. I think the foreign body wasn't appropriate in my opinion.

 

[posner]

I guess I would code conservatively only because in good consciousness, the foreign body wasn't by accident. Let's suppose the patient came from another doctor. The appropriate diagnosis isn't foreign body but granulation or even nasolacrimal duct obstruction. Code for those problems. I think the foreign body wasn't appropriate in my opinion.

I agree with you about the foreign body being inappropriate in this case. I was trying to get clarification in regards to the regular E/M codes vs the procedure code 65222 in this case. It seemed like you were recommending the other doc not bill for the procedure but do bill for the appropriate E/M code for the visit. This would have been my suggestion as well.

Posner