Recurrent corneal erosion (RCE) is a painful and frustrating condition for both patients and practitioners. Patients struggle with the ongoing discomfort, while practitioners struggle with stabilizing the condition long-term. The patient encounters necessary for RCE can also cause coding angst. Here’s what you need to know.
Many RCE conditions are present because of a prior incident to the cornea such as a corneal foreign body that never healed properly. Thus, coding considerations for RCE should include a thorough history of the previous injury or insult to the eye, in addition to the current methods of evaluation and treatment plans.
The ICD-10 stipulates that, with injury-related sequelae, we are obligated to code the sequelae first and the original injury second. For example, if a corneal foreign body was removed from the right eye months ago and the area did not heal properly, causing an RCE, the ICD-10 coding attached to the office visit would be:
H18.831: Recurrent erosion of cornea, right eye
T15.01XS: Foreign body in cornea, right eye, sequela
You must claim the current condition as the primary diagnosis, which tells the carrier what we are dealing with today; the second diagnosis tells the carrier the original injury that occurred and that today is a sequela of that.
Coding the office visit follows the standard rules regarding E/M coding, based on your history, physical examination, medical decision making and if the patient is new or established. In most cases, this would be a 99202/03 or a 99213/14, depending on the individual patient.
The treatment options for RCEs range from surgical debridement of the area and application of a bandage contact lens to a phototherapeutic keratectomy (PTK) procedure or a stromal puncture, depending on what your scope of practice allows. Here are the CPT codes for each therapy:
65435: Removal of corneal epithelium; with or without chemocauterization (abrasion, currettage)
65600: Multiple punctures of the anterior cornea (e.g., for corneal erosion, tattoo)
92071: Fitting of a contact lens for treatment of ocular surface disease
Both 65435 and 65600 are surgical procedures; 65435 is a minor procedure with a global period of less than 90 days, while 65600 is a major surgical procedure with a global period of 90 days. The rules here differ significantly.
Coding for an office visit on the same day as a minor surgical procedure is rarely done because the visit itself is already incorporated into the surgical code and reimbursement. However, this is not the case with major surgical procedures. To bill an office visit on the same day as a major surgical procedure, append modifier -57 (decision to perform major surgery) to the E/M office visit code.
So, if you were to perform an office visit and debridement only, you would code just the 65435 in most cases. If you were to perform an office visit and multiple punctures of the anterior cornea, you would code 992XX-57 and 65600. Keep in mind that the global period with 65435 is zero days and the global period with 65600 is 90 days.
PTK, if within the scope of your licensure, is generally not a reimbursable procedure because it is a level II HCPCS code (S), which is generally payable by the patient. If you submit to a third-party carrier, be sure to obtain a properly completed Advance Beneficiary Notice form to ensure that if the carrier denies the claim you are reimbursed by the patient.
Lastly, don’t forget the CCI edits with respect to the bandage contact lens, 92071. Billing an office visit and a bandage contact lens fit (992XX and 92071) are allowed and are covered if performed on the same date of service. However, if a bandage lens is fit on the same day as any surgical procedure, you cannot bill for it.
Recurrent corneal erosion is a condition that often requires constant and periodic monitoring within your practice. Understanding both the contemporary management techniques and the subsequent medical coding compliance issues is key to successful encounters. In doing so, you can reduce your audit risk exposure and rejected claims—a significant benefit to a well-run, compliant and profitable practice.
Send your own coding questions and comments to firstname.lastname@example.org.