Eye flush is included in E/M facility code
APCs Weekly Monitor, August 24, 2003
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New OCE does more than edit In order to handle claims with service dates that span more than one calendar day, the October OCE version V4.3 will process claims with multiple days of services, and provide additional information about errors. The original OCE focused only on the presence or absence of specific edits and did not suggest any solution to the edits. It was structured to return a set of flags for each diagnosis and procedure to specify the presence or absence of individual edits. The revised OCE identifies individual errors, points out ways to fix them, and explains why these actions are necessary, according to PM A-03-069, published August 8, 2003. The revised OCE needs to be installed by October 1, 2003. CMS will issue it before then, unless a notice of further delay is announced. Starting with unprocessed claims with dates of service on or after August 1, 2000, the following bill types must be processed through the revised OCE:
All other outpatient bill types with dates of service April 1, 2002, and later, (22X, 23X, 24X, 32X, 33X, 71X, 72X, 73X, 74X, 81X or 82X) should also be processed, as well as outpatient bill types 34X and 75X that contain services other than those listed above with dates of service April 1, 2002 and later. Do not send claims from Indian Health Service hospitals, critical access hospitals (CAHs), hospitals located in American Samoa, Guam, Saipan, and the state of Maryland, or the Virgin Islands with dates of service January 1, 2002, and later, and claims from hospitals that furnish only inpatient Part B services with dates of service January 1, 2002, and later. They are all excluded from OPPS.
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Each week, our team of experts answers a question that will appeal to
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answer are delivered to your inbox every Friday. TODAY'S TOPIC: Eye flush is included in E/M facility code Question: A patient was seen in the ED after he spilled chemicals into his eye. The ED physician irrigated the eye with more than three liters of saline. Can we assign CPT code 65205 for removal of foreign body (chemicals being the foreign body) or would the procedure be included in the facility E/M code? Answer: The irrigation of the eye is included in the facility E/M visit code. CPT code 65205, "removal of superficial foreign body, external eye, conjunctival, superficial," is not appropriate in this instance because the eye is being flushed and no foreign body is actually being removed. Although the CPT Assistant and Coder's Desk Reference do not define a foreign body, in practice it is considered as a solid object, such as a splinter of metal or wood. The descriptor for 65205 alludes to this, as it states, "The physician picks the foreign body or mineral deposit from the conjunctiva with the side of the beveled edge of a needle (e.g., 65205). A small incision may be required to remove an embedded foreign body (e.g., 65210)." TIP OF THE WEEK: Explain the effects of poor documentation to physicians Coding and Compliance Feature Article of the Month: Use official coding guidelines for general rules, create facility-specific guidelines for consistency
Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations. EDITOR'S CHOICE Coding Lunch & Learn for severity coding! It's time for another "Coding Lunch & Learn session." Gather your colleagues for a brown bag lunch and listen to the easy-to-understand program on secondary diagnosis coding program from HP3 and HCPro. There are specific details of ICD-9 code assignment required to capture the appropriate level of severity and quality of care outcomes. Train every member of the staff and award everyone valuable continuing education credits while they "Lunch & Learn." For more information, CLICK HERE or call our customer service department at 800/650-6787. Be sure to mention source code EZ0839A What do you know about interventional radiology coding? Interventional radiology coding is a unique process. It's not like other kinds of coding, where one (or a few) codes describe every aspect of a procedure. With interventional radiology, every component must be coded separately— and accurately— or the claim won't be paid on time. Join us for "Interventional Radiology Coding: How to Ensure Accurate Coding to Get Your Claims Paid the First Time" on Thursday September 25, beginning at 1 p.m. Eastern. For more information or to register, CLICK HERE, or call our Customer Service Team at 800/650-6787. Be sure to mention source code EZ21919A. Want to receive articles like this one in your inbox? Subscribe to APCs Weekly Monitor! Related Products
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