Comprehension, caution can prevent surgical coding errors

Part 1 of a two-part series on common CPT coding errors.

Riva Lee Asbell

Many surgical coding mistakes result from misinterpretation of Current Procedural Terminology (CPT) wording. When the CPT editorial panel works on a code description, significant time is spent dissecting each word used. Unfortunately, most people attempting to code procedures are not privy to this process and fail to understand how the code is meant to be used.

This two-part series presents some of the more common errors encountered in audits of physician and ASC surgical coding.

CPT rules

The instructions for using the CPT code book specifically state, “Select the name of the procedure or service that accurately identifies the service performed. Do not select a CPT code that merely approximates the service provided. If no such specific code exists, then report the service using the appropriate unlisted procedure or service code. In surgery it may be an operation …”

Some of the worst surgical coding advice given in courses and chat rooms starts with, “You can try this and see if you get paid,” or “Consider using … ” or “I got paid using ….” You cannot arbitrarily use another code if it does not describe what was performed. This type of erroneous suggestion leads to mistakes that are compounded by lack of basic comprehension of the English definitions and how they are used in a coding context.

Getting paid means just that — you were paid. Medicare or other insurers can and do come back and recoup the payment.

Well-intentioned advice can result in erroneous coding and loss of revenue as well as audits. If there is not a code for what is being performed, then use the unlisted code.

The following are the most common unlisted codes used in ophthalmology and ophthalmic plastic surgery:

• 17999 Unlisted procedure, skin, mucous membrane and subcutaneous tissue
• 21499 Unlisted procedure, musculoskeletal procedure, head
• 64999 Unlisted procedure, nervous system
• 66999 Unlisted procedure, anterior segment of eye
• 67299 Unlisted procedure, posterior segment
• 67399 Unlisted procedure, ocular muscle
• 67599 Unlisted procedure, orbit
• 67999 Unlisted procedure, eyelids
• 68399 Unlisted procedure, conjunctiva
• 68899 Unlisted procedure, lacrimal system

Removal of implant vs. removal of foreign body

Foreign body, in coding terms, is an object that has entered and is present in the body but does not belong there and was not placed by the surgeon. This includes objects that are synthetic or natural in origin (wood, glass, metal, etc.).

In ophthalmology the list of foreign body sites includes:

• Corneal foreign bodies
• Intraocular foreign bodies (anterior and posterior segments)
• Foreign substances embedded in lacerations
• Conjunctival foreign bodies
• Orbital foreign bodies

Obviously, these objects arrive in the body part as a result of some type of trauma, such as an accident, natural force (wind blowing something in the eye) or other method of delivery.

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.

Do not code the removal of an implant as removal of a foreign body.

In many instances there is not a code for removal of an implant, or its removal or revision may be included in the placement code. An example of this is CPT code 67218 (Destruction of localized lesion of retina … radiation by implantation of source [includes removal of source]).

Therefore, coding the removal of a previously placed implant often requires use of one of the unlisted codes.

Examples of specific ophthalmic codes that address removal of implanted material include:

• 65175 Removal of ocular implant
• 65920 Removal of implanted material, anterior segment of eye
• 67120 Removal of implanted material, posterior segment, extraocular
• 67121 Removal of implanted material, posterior segment, intraocular
• 67560 Orbital implant (implant outside muscle cone); removal or revision

Examples of specific ophthalmic codes that address removal of foreign bodies include:

• 65205 Removal of foreign body, external eye; conjunctival superficial
• 65210 Removal of foreign body, external eye; conjunctival embedded
• 65220 Removal of foreign body, external eye; corneal, without slit lamp
• 65222 Removal of foreign body, external eye; corneal, with slit lamp
• 65235 Removal of foreign body, intraocular; from anterior chamber of eye
• 65260 Removal of foreign body, intraocular; from posterior segment, magnetic extraction
• 65265 Removal of foreign body, intraocular; from posterior segment, nonmagnetic extraction
• 67413 Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of foreign body
• 67430 Orbitotomy with bone flap or window, lateral approach (Kronlein); with removal of foreign body
• 67938 Removal of embedded foreign body, eyelid

Examples of procedures that should not be coded as removal of foreign body include: removal of silicone tubes from the nasolacrimal system (do not use 30300 or 65830); removal of punctal plugs (do not use 68530); removal of orbital implants placed to correct orbital floor fractures; removal of enucleation or evisceration implants.

• Riva Lee Asbell is president of Riva Lee Asbell Associates, an ophthalmic reimbursement consulting firm, and a clinical assistant professor of surgery (ophthalmology) at the University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School at Camden. She can be reached at RivaLee@aol.com; website: www.RivaLeeAsbell.com.
• CPT codes, copyright 2010, American Medical Association