conjunctiva · 2019-11-28 · conjunctiva and tenon's capsule as possible. he removes the eye...

ContentsIntroduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

General . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Integumentary System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Eye and Ocular Adnexa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Operating Microscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .275

Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .276

Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .290

Evaluation and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .352

Category III Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .418

HCPCS Codes

• Medical and Surgical Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .438

• Miscellaneous Drugs, Biologicals, and Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .439

• Procedures/Professional Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .440

• Drugs Administered Other Than Oral Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .450

• Prosthetic Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .452

• Temporary Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .453

• Temporary National Codes (Non-Medicare) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .454

• National Codes Established for State Medicaid Agencies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .462

• Vision Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .463

ICD-10 CrossRef Details. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .497

Modifier Definitions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .591

Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .601

Code Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .623

13Modifier: 0 = not allowed, 1 = allowed

© 2019 The Coding Institute

CPT® is a registered trademark of the American Medical Association. CPT © 2019 American Medical Association. All rights reserved.

Eye and Ocular Adnexa Coders’ Specialty Guide 2020: Ophthalmology/Optometryey

e an

d O

CU

lar

ad

nex

a65091 —

6509365091 — 65093

65091Evisceration of ocular contents; without implant

Clinical responsibilityWhen the patient is appropriately prepped and anesthetized, the provider makes an incision at the limbus using a surgical blade and excises the cornea with curved scissors. He then removes the intraocular contents using an evisceration spoon and closes the scleral wound with sutures. He applies antibiotic drops. He closes Tenon's capsule and the conjunctiva in separate overlying layers.

Coding TipsA provider may fit and place an orbital conformer, a placeholder for the missing eye, under general anesthesia. How to code this depends on the situation in which you are placing the orbital conformer. If you are placing the conformer as part of an enucleation or evisceration procedure, you would not bill separately for the procedure as it would be included in the surgical code. Because an orbital conformer is a temporary implant, when billing the surgical procedure you would select the code that states in its description without implant. The two code choices would be 65091 and 65101, Enucleation of eye, without implant. When placing a permanent implant, use the code that includes an implant to report the service. If you are placing the conformer for the repair of symblepharon, which is an adhesion between conjunctival surfaces that may be caused by inflammation, trauma or previous surgery, you should use 68340, Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens.

For the same service with implantation, see 65093, Evisceration of ocular contents, with implant.

Illustration

Conjunctiva

Incision

line

Removed contents

through incision

Contents of

eyeball

65091

Fee ScheduleMedicare Fees national Conversion Factor: 36.0391, Facility: $663.12, Non Facility: $663.12, OPPS Facility: $261.64, OPPS Non Facility: $261.64rVU Facility Work RVU: 7.26, PE RVU: 10.62, Malpractice RVU: 0.52, Total RVU: 18.40rVU non-Facility Work RVU: 7.26, PE RVU: 10.62, Malpractice RVU: 0.52, Total RVU: 18.40Indicators Preoperative: 10.00, Intraoperative: 70.00, Postoperative: 20.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: None, MUE: 1Modifier allowances 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XU

CCI Alerts (version 24.3)0213T0, 0216T0, 0228T0, 0230T0, 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 120371, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, 131311, 131321, 131331, 131511, 131521, 131531, 360001, 364001, 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 437521, 517011, 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645080, 645100, 645170, 645200, 645300, 675001, 699900, 920121, 920141, 920181, 920191, 930001, 930051, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 963761, 963771, 991550, 991560, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994950, 994960, G04631, G04711, J06701, J20011

ICD-10 CrossRefH21.331-H21.339, H33.121-H33.129, H44.001-H44.009, H44.011-H44.019, H44.121-H44.129, H44.511-H44.519, H44.521-H44.529, S05.20XA, S05.21XA, S05.22XA, S05.40XA, S05.41XA, S05.42XA, S05.50XA, S05.51XA, S05.52XA

65093Evisceration of ocular contents; with implant

14 Modifier: 0 = not allowed, 1 = allowed © 2019 The Coding Institute


Eye and Ocular AdnexaCoders’ Specialty Guide 2020: Ophthalmology/Optometryey

e a

nd

OC

Ula

r a

dn

exa

6510

1 —

651

0165101 — 65101

Clinical responsibilityWhen the patient is appropriately prepped and anesthetized, the provider makes an incision at the limbus using a surgical blade and excises the cornea with curved scissors. He then removes the intraocular contents using an evisceration spoon. He makes small incisions in the sclera and places the implant, using an insertion device and forceps, or pincers, in the scleral shell. He closes the sclera with nonabsorbable suture and closes Tenon's capsule and the conjunctiva in separate overlying layers. Finally, he places an orbital conformer behind the eyelids and applies a pressure patch.

Coding TipsFor the same service without implantation, see 65091, Evisceration of ocular contents, without implant.

Fee ScheduleMedicare Fees national Conversion Factor: 36.0391, Facility: $656.27, Non Facility: $656.27, OPPS Facility: $253.72, OPPS Non Facility: $253.72rVU Facility Work RVU: 7.04, PE RVU: 10.65, Malpractice RVU: 0.52, Total RVU: 18.21rVU non-Facility Work RVU: 7.04, PE RVU: 10.65, Malpractice RVU: 0.52, Total RVU: 18.21Indicators Preoperative: 10.00, Intraoperative: 70.00, Postoperative: 20.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: None, MUE: 1Modifier allowances 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XU

CCI Alerts (version 24.3)0213T0, 0216T0, 0228T0, 0230T0, 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 120371, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, 131311, 131321, 131331, 131511, 131521, 131531, 360001, 364001, 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 437521, 517011, 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645080, 645100, 645170, 645200, 645300, 650911, 651031, 651051, 651301, 675001, 699900, 920121, 920141, 920181, 920191, 930001, 930051, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 963761, 963771, 991550, 991560, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351,

993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994950, 994960, G04631, G04711, J06701, J20011

ICD-10 CrossRefH21.331-H21.339, H33.121-H33.129, H44.001-H44.009, H44.011-H44.019, H44.121-H44.129, H44.511-H44.519, H44.521-H44.529, S05.20XA, S05.21XA, S05.22XA, S05.40XA, S05.41XA, S05.42XA, S05.50XA, S05.51XA, S05.52XA

65101Enucleation of eye; without implant

Clinical responsibilityWhen the patient is appropriately prepped and anesthetized, the provider performs a limbal peritomy, an incision around the perimeter of the cornea, while preserving as much of the conjunctiva and Tenon's capsule as possible. He removes the eye from the socket and places gauze soaked in saline solution into the socket to control bleeding. He places a temporary orbital conformer, which helps preserve the shape of the eyelids until a final prosthesis is made. Finally, he applies a pressure patch over the eyelid.

Coding TipsA provider may fit and place an orbital conformer, a placeholder for the missing eye, under general anesthesia. How to code this depends on the situation in which you are placing the orbital conformer. If you are placing the conformer as part of an enucleation or evisceration procedure, you would not bill separately for the procedure as it would be included in the surgical code. Because an orbital conformer is a temporary implant, when billing the surgical procedure you would select the code that states in its description without implant. The two code choices would be 65091 and 65101, Enucleation of eye, without implant. When placing a permanent implant, use the code that includes an implant to report the service. If you are placing the conformer for the repair of symblepharon, which is an adhesion between conjunctival surfaces that may be caused by inflammation, trauma or previous surgery, you should use 68340, Repair of symblepharon; division of symblepharon, with or without insertion of conformer or contact lens.





e an

d O

CU

lar

ad

nex

a65103 —

6510365103 — 65103

IllustrationEyeball

removed

Extraocular

muscle Conjunctiva

Optic

nerve

65101

Fee ScheduleMedicare Fees national Conversion Factor: 36.0391, Facility: $770.16, Non Facility: $770.16, OPPS Facility: $299.12, OPPS Non Facility: $299.12rVU Facility Work RVU: 8.30, PE RVU: 12.47, Malpractice RVU: 0.60, Total RVU: 21.37rVU non-Facility Work RVU: 8.30, PE RVU: 12.47, Malpractice RVU: 0.60, Total RVU: 21.37Indicators Preoperative: 10.00, Intraoperative: 70.00, Postoperative: 20.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: None, MUE: 1Modifier allowances 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XU

CCI Alerts (version 24.3)0213T0, 0216T0, 0228T0, 0230T0, 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 120371, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, 131311, 131321, 131331, 131511, 131521, 131531, 360001, 364001, 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 437521, 517011, 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645080, 645100, 645170, 645200, 645300, 675001, 699900, 920121, 920141, 920181, 920191, 930001, 930051, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 963761, 963771, 991550, 991560, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181,

992191, 992201, 992211, 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994950, 994960, G04631, G04711, J06701, J20011

ICD-10 CrossRefC69.00-C69.02, C69.10-C69.12, C69.20-C69.22, C69.30-C69.32, C69.40-C69.42, C69.60-C69.62, C69.80-C69.82, C69.90-C69.92, D09.20-D09.22, H05.411-H05.419, H05.421-H05.429, H40.30X3, H40.31X3, H40.32X3, H40.33X3, H40.40X3, H40.41X3, H40.42X3, H40.43X3, H40.50X3, H40.51X3, H40.52X3, H40.53X3, H44.511-H44.519, H44.521-H44.529, H59.351-H59.359, Q11.0, S05.20XA, S05.20XD, S05.21XA, S05.21XD, S05.22XA, S05.22XD, S05.50XA, S05.50XD, S05.51XA, S05.51XD, S05.52XA, S05.52XD, Z44.20-Z44.22

65103Enucleation of eye; with implant, muscles not attached to implant

Clinical responsibilityWhen the patient is appropriately prepped and anesthetized, the provider performs a limbal peritomy, an incision around the perimeter of the cornea while preserving as much of the conjunctiva and Tenon's capsule as possible. He removes the eye from the socket and places gauze soaked in saline solution into the socket to control bleeding. He selects and inserts an appropriately sized nonintegrated implant. He then attaches conjunctiva and Tenon's capsule and sutures them in place. Finally, he uses an absorbable suture to close the conjunctiva and applies a pressure patch.

Coding TipsYour provider may use a surgical assistant during this procedure, and you should check whether your insurers will pay for that. For instance, if you review the Medicare Provider Fee Schedule, you'll see that Medicare assigns the 2 indicator to this code in the ASST SURG column, which means that payment restrictions for assistants at surgery do not apply to this particular procedure and that an assistant at surgery may be paid, according to Medicare, although without a guarantee. Therefore, you should bill for a surgical assistant during these procedures if the documentation demonstrates medical necessity for the assist. If the payer accepts the assistant surgeon's charge, you'll append modifier 80, Assistant surgeon, for the services of the assisting provider.

Do note that if the surgical assistant is not a provider, you may be required to use modifier AS, Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery, to represent the assistant's work. Check with your payer for their preference.




e a

nd

OC

Ula

r a

dn

exa

6510

5 —

651

0565105 — 65105

IllustrationEyeball

removed

Eyeball

removed

Extraocular

muscle Conjunctiva

Optic

nerve

Artificial eyeball

is implanted

eba

d

all

Extraocular

muscle

65103, 65105

Fee ScheduleMedicare Fees national Conversion Factor: 36.0391, Facility: $801.87, Non Facility: $801.87, OPPS Facility: $318.59, OPPS Non Facility: $318.59rVU Facility Work RVU: 8.84, PE RVU: 12.76, Malpractice RVU: 0.65, Total RVU: 22.25rVU non-Facility Work RVU: 8.84, PE RVU: 12.76, Malpractice RVU: 0.65, Total RVU: 22.25Indicators Preoperative: 10.00, Intraoperative: 70.00, Postoperative: 20.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: None, MUE: 1Modifier allowances 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XU

CCI Alerts (version 24.3)0213T0, 0216T0, 0228T0, 0230T0, 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 120371, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, 131311, 131321, 131331, 131511, 131521, 131531, 360001, 364001, 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 437521, 517011, 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645080, 645100, 645170, 645200, 645300, 651011,

651351, 675001, 699900, 920121, 920141, 920181, 920191, 930001, 930051, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 963761, 963771, 991550, 991560, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994950, 994960, G04631, G04711, J06701, J20011

ICD-10 CrossRefC69.00-C69.02, C69.10-C69.12, C69.20-C69.22, C69.30-C69.32, C69.40-C69.42, C69.60-C69.62, C69.80-C69.82, C69.90-C69.92, D09.20-D09.22, H05.411-H05.419, H05.421-H05.429, H40.30X3, H40.31X3, H40.32X3, H40.33X3, H40.40X3, H40.41X3, H40.42X3, H40.43X3, H40.50X3, H40.51X3, H40.52X3, H40.53X3, H44.511-H44.519, H44.521-H44.529, H59.351-H59.359, M79.10, M79.18, Q11.0, S05.20XA, S05.20XD, S05.21XA, S05.21XD, S05.22XA, S05.22XD, S05.50XA, S05.50XD, S05.51XA, S05.51XD, S05.52XA, S05.52XD, Z44.20-Z44.22

65105Enucleation of eye; with implant, muscles attached to implant

Clinical responsibilityWhen the patient is appropriately prepped and anesthetized, the provider performs a limbal peritomy, an incision around the perimeter of the cornea, while preserving as much of the conjunctiva and Tenon's capsule as possible. He removes the eye from the socket and places gauze soaked in saline solution into the socket to control bleeding. He selects an appropriately sized implant and places it in the socket. He then attaches the extraocular muscles and each of the four rectus muscles that hold the eye in place, to the implant. He uses sutures to close the Tenon's capsule, and finally, closes the conjunctiva. He then applies a pressure patch over the eyelid.

Coding TipsFor the same service with muscles not attached to implant, report 65103, Enucleation of eye, with implant, muscles not attached to implant. For the same service without placement of an implant, report 65101, Enucleation of eye, without implant.

Fee ScheduleMedicare Fees national Conversion Factor: 36.0391, Facility: $882.60, Non Facility: $882.60, OPPS Facility: $357.87, OPPS Non Facility: $357.87rVU Facility Work RVU: 9.93, PE RVU: 13.83, Malpractice RVU: 0.73, Total RVU: 24.49





e an

d O

CU

lar

ad

nex

a65110 —

6511065110 — 65110

rVU non-Facility Work RVU: 9.93, PE RVU: 13.83, Malpractice RVU: 0.73, Total RVU: 24.49Indicators Preoperative: 10.00, Intraoperative: 70.00, Postoperative: 20.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: None, MUE: 1Modifier allowances 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XU

CCI Alerts (version 24.3)0213T0, 0216T0, 0228T0, 0230T0, 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 120371, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, 131311, 131321, 131331, 131511, 131521, 131531, 360001, 364001, 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 437521, 517011, 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645080, 645100, 645170, 645200, 645300, 651011, 651031, 651401, 675001, 699900, 920121, 920141, 920181, 920191, 930001, 930051, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 963761, 963771, 991550, 991560, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994950, 994960, G04631, G04711, J06701, J20011

ICD-10 CrossRefC69.00-C69.02, C69.10-C69.12, C69.20-C69.22, C69.30-C69.32, C69.40-C69.42, C69.60-C69.62, C69.80-C69.82, C69.90-C69.92, D09.20-D09.22, H05.411-H05.419, H05.421-H05.429, H40.30X3, H40.31X3, H40.32X3, H40.33X3, H40.40X3, H40.41X3, H40.42X3, H40.43X3, H40.50X3, H40.51X3, H40.52X3, H40.53X3, H44.511-H44.519, H44.521-H44.529, H59.351-H59.359, M79.10, M79.18, Q11.0, S05.20XA, S05.20XD, S05.21XA, S05.21XD, S05.22XA, S05.22XD, S05.50XA, S05.50XD, S05.51XA, S05.51XD, S05.52XA, S05.52XD, Z44.20-Z44.22

65110Exenteration of orbit (does not include skin graft), removal of orbital contents; only

Clinical responsibilityWhen the patient is appropriately prepped and anesthetized, the provider passes a suture through the eyelid skin and orbicularis and then passes it through the tarsal plate and secures the lids together. He makes an incision approximately close to the lid margin to spare the eyelids in this procedure. He separates the periorbita from the bone. On reaching the orbital apex, or peak, he clamps the tissues, makes an incision, and extracts the contents. He places dry gauze in the orbit, closes the wound using sutures, and applies a pressure patch.

Coding TipsExenteration should be differentiated from evisceration, which removes the orbital contents, leaving the sclera intact, and enucleation, which removes the orbital contents, including the sclera. Select the appropriate code from the section enumerated 65091 to 65014, Removal procedures of eye contents. Care should be taken when reporting 65112. In case the provider preserves the orbital bone, use code 65110, Exenteration of orbit, does not include skin graft, removal of orbital contents, only.

Your provider may use a surgical assistant during this procedure, and you should check whether your insurers will pay for that. For instance, if you review the Medicare Provider Fee Schedule, you'll see that Medicare assigns the 2 indicator to this code in the ASST SURG column, which means that payment restrictions for assistants at surgery do not apply to this particular procedure and that an assistant at surgery may be paid, according to Medicare, although without a guarantee. Therefore, you should bill for a surgical assistant during these procedures if the documentation demonstrates medical necessity for the assist. If the payer accepts the assistant surgeon's charge, you'll append modifier 80, Assistant surgeon, for the services of the assisting provider.

Do note that if the surgical assistant is not a provider, you may be required to use modifier AS, Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery, to represent the assistant's work. Check with your payer for their preference.

Illustration

65110




e a

nd

OC

Ula

r a

dn

exa

6511

2 —

651

1265112 — 65112

Fee ScheduleMedicare Fees national Conversion Factor: 36.0391, Facility: $1,263.17, Non Facility: $1,263.17, OPPS Facility: $565.81, OPPS Non Facility: $565.81rVU Facility Work RVU: 15.70, PE RVU: 18.21, Malpractice RVU: 1.14, Total RVU: 35.05rVU non-Facility Work RVU: 15.70, PE RVU: 18.21, Malpractice RVU: 1.14, Total RVU: 35.05Indicators Preoperative: 10.00, Intraoperative: 70.00, Postoperative: 20.00, Total RVU: 100, Global Period: 090, Radiology Diagnostic Test: 99, Code Status: A, PC/TC Indicator: 0, Endoscopic Base Code: None, MUE: 1Modifier allowances 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XU

CCI Alerts (version 24.3)0213T0, 0216T0, 0228T0, 0230T0, 110001, 110011, 110041, 110051, 110061, 110421, 110431, 110441, 110451, 110461, 110471, 120011, 120021, 120041, 120051, 120061, 120071, 120111, 120131, 120141, 120151, 120161, 120171, 120181, 120201, 120211, 120311, 120321, 120341, 120351, 120361, 120371, 120411, 120421, 120441, 120451, 120461, 120471, 120511, 120521, 120531, 120541, 120551, 120561, 120571, 131001, 131011, 131021, 131201, 131211, 131221, 131311, 131321, 131331, 131511, 131521, 131531, 312251, 360001, 364001, 364051, 364061, 364101, 364201, 364251, 364301, 364401, 365910, 365920, 366001, 366401, 437521, 517011, 517021, 517031, 623200, 623210, 623220, 623230, 623240, 623250, 623260, 623270, 644000, 644020, 644050, 644080, 644100, 644130, 644150, 644160, 644170, 644180, 644200, 644210, 644250, 644300, 644350, 644450, 644460, 644470, 644480, 644490, 644500, 644610, 644620, 644630, 644790, 644800, 644830, 644840, 644860, 644870, 644880, 644890, 644900, 644910, 644920, 644930, 644940, 644950, 645050, 645080, 645100, 645170, 645200, 645300, 650911, 650931, 651011, 651031, 651051, 675001, 699900, 920121, 920141, 920181, 920191, 930001, 930051, 930101, 930401, 930411, 930421, 933181, 933551, 940021, 942001, 942501, 946801, 946811, 946901, 947701, 958121, 958131, 958161, 958191, 958221, 958291, 959551, 963601, 963611, 963651, 963661, 963671, 963681, 963721, 963741, 963751, 963761, 963771, 975971, 975981, 976021, 991550, 991560, 991570, 992111, 992121, 992131, 992141, 992151, 992171, 992181, 992191, 992201, 992211, 992221, 992231, 992311, 992321, 992331, 992341, 992351, 992361, 992381, 992391, 992411, 992421, 992431, 992441, 992451, 992511, 992521, 992531, 992541, 992551, 992911, 992921, 993041, 993051, 993061, 993071, 993081, 993091, 993101, 993151, 993161, 993341, 993351, 993361, 993371, 993471, 993481, 993491, 993501, 993741, 993751, 993771, 993781, 994460, 994470, 994480, 994490, 994950, 994960, G04631, G04711, J06701, J20011

ICD-10 CrossRefC41.0, C43.10, C44.101, C44.111, C44.121, C44.191, C69.00-C69.02, C69.10-C69.12, C69.20-C69.22, C69.30-C69.32, C69.40-C69.42, C69.50-C69.52, C69.60-C69.62, C69.80-C69.82, C69.90-C69.92, D03.10, H57.89

65112Exenteration of orbit (does not include skin graft), removal of orbital contents; with therapeutic removal of bone

Clinical responsibilityWhen the patient is appropriately prepped and anesthetized, the provider passes a suture through the eyelid skin and orbicularis and then passes it through the tarsal plate and secures the lids together. He makes an incision approximately close to the lid margin to spare the eyelids in this procedure. Alternatively, he makes an incision just inside the orbital rim, sacrificing the eyelids. He separates the periorbita from the bone. On reaching the orbital apex, or peak, he clamps the tissues, makes an incision, and extracts the contents. He removes excess bony tissue. He places dry gauze in the orbit, closes the wound using sutures, and applies a pressure patch.

Coding TipsExenteration should be differentiated from evisceration, which removes the orbital contents, leaving the sclera intact, and enucleation, which removes the orbital contents, including the sclera. Select the appropriate code from the section enumerated 65091 to 65014, Removal procedures of eye contents. Care should be taken when reporting 65112. In case the provider preserves the orbital bone, use code 65110, Exenteration of orbit, does not include skin graft, removal of orbital contents, only.

IllustrationEyeball

removed dremoveed

Conjunctiva

Optic

nerve

Removal

of bone

65112

Fee ScheduleMedicare Fees national Conversion Factor: 36.0391, Facility: $1,462.47, Non Facility: $1,462.47, OPPS Facility: $667.08, OPPS Non Facility: $667.08rVU Facility Work RVU: 18.51, PE RVU: 20.74, Malpractice RVU: 1.33, Total RVU: 40.58

497© 2019 The Coding Institute

ICD

-10 Cr

ossr

ef Deta

Ilsa

02.1 — C

00.2

ICD-10 CrossRef Detailsa02.1 Salmonella sepsisa18.50 Tuberculosis of eye, unspecifieda18.51 Tuberculous episcleritisa18.52 Tuberculous keratitisa18.53 Tuberculous chorioretinitisa18.54 Tuberculous iridocyclitisa18.59 Other tuberculosis of eyea22.7 Anthrax sepsisa26.7 Erysipelothrix sepsisa32.7 Listerial sepsisa36.86 Diphtheritic conjunctivitisa40.0 Sepsis due to streptococcus, group Aa40.1 Sepsis due to streptococcus, group Ba40.3 Sepsis due to Streptococcus pneumoniaea40.8 Other streptococcal sepsisa40.9 Streptococcal sepsis, unspecifieda41.01 Sepsis due to Methicillin susceptible Staphylococcus aureusa41.02 Sepsis due to Methicillin resistant Staphylococcus aureusa41.1 Sepsis due to other specified staphylococcusa41.2 Sepsis due to unspecified staphylococcusa41.3 Sepsis due to Hemophilus influenzaea41.4 Sepsis due to anaerobesa41.50 Gram-negative sepsis, unspecifieda41.51 Sepsis due to Escherichia coli [E. coli]a41.52 Sepsis due to Pseudomonasa41.53 Sepsis due to Serratiaa41.59 Other Gram-negative sepsisa41.81 Sepsis due to Enterococcusa41.89 Other specified sepsisa41.9 Sepsis, unspecified organisma42.7 Actinomycotic sepsisa49.01 Methicillin susceptible Staphylococcus aureus infection,

unspecified sitea49.02 Methicillin resistant Staphylococcus aureus infection,

unspecified sitea49.8 Other bacterial infections of unspecified sitea50.31 Late congenital syphilitic interstitial keratitisa51.43 Secondary syphilitic oculopathya51.9 Early syphilis, unspecifieda52.15 Late syphilitic neuropathya52.19 Other symptomatic neurosyphilisa52.71 Late syphilitic oculopathya54.30 Gonococcal infection of eye, unspecifieda54.31 Gonococcal conjunctivitisa54.32 Gonococcal iridocyclitisa54.33 Gonococcal keratitisa54.39 Other gonococcal eye infectiona54.86 Gonococcal sepsisa63.0 Anogenital (venereal) wartsa71.0 Initial stage of trachomaa71.1 Active stage of trachomaa71.9 Trachoma, unspecifieda74.0 Chlamydial conjunctivitisB00.50 Herpesviral ocular disease, unspecifiedB00.51 Herpesviral iridocyclitisB00.52 Herpesviral keratitisB00.53 Herpesviral conjunctivitisB00.59 Other herpesviral disease of eyeB00.89 Other herpesviral infectionB00.9 Herpesviral infection, unspecifiedB02.0 Zoster encephalitisB02.29 Other postherpetic nervous system involvementB02.30 Zoster ocular disease, unspecifiedB02.31 Zoster conjunctivitisB02.32 Zoster iridocyclitisB02.33 Zoster keratitis

B02.34 Zoster scleritisB02.39 Other herpes zoster eye diseaseB02.9 Zoster without complicationsB05.81 Measles keratitis and keratoconjunctivitisB05.9 Measles without complicationB07.8 Other viral wartsB07.9 Viral wart, unspecifiedB08.1 Molluscum contagiosumB09 Unspecified viral infection characterized by skin and mucous

membrane lesionsB10.81 Human herpesvirus 6 infectionB10.89 Other human herpesvirus infectionB17.9 Acute viral hepatitis, unspecifiedB18.2 Chronic viral hepatitis CB19.20 Unspecified viral hepatitis C without hepatic comaB19.9 Unspecified viral hepatitis without hepatic comaB20 Human immunodeficiency virus [HIV] diseaseB25.2 Cytomegaloviral pancreatitisB25.8 Other cytomegaloviral diseasesB25.9 Cytomegaloviral disease, unspecifiedB30.0 Keratoconjunctivitis due to adenovirusB30.1 Conjunctivitis due to adenovirusB30.2 Viral pharyngoconjunctivitisB30.3 Acute epidemic hemorrhagic conjunctivitis (enteroviral)B30.8 Other viral conjunctivitisB30.9 Viral conjunctivitis, unspecifiedB37.7 Candidal sepsisB37.89 Other sites of candidiasisB39.4 Histoplasmosis capsulati, unspecifiedB39.5 Histoplasmosis duboisiiB39.9 Histoplasmosis, unspecifiedB44.89 Other forms of aspergillosisB55.2 Mucocutaneous leishmaniasisB58.00 Toxoplasma oculopathy, unspecifiedB58.01 Toxoplasma chorioretinitisB58.09 Other toxoplasma oculopathyB58.9 Toxoplasmosis, unspecifiedB60.12 Conjunctivitis due to AcanthamoebaB60.13 Keratoconjunctivitis due to AcanthamoebaB69.1 Cysticercosis of eyeB73.00 Onchocerciasis with eye involvement, unspecifiedB73.01 Onchocerciasis with endophthalmitisB73.02 Onchocerciasis with glaucomaB73.09 Onchocerciasis with other eye involvementB74.9 Filariasis, unspecifiedB78.1 Cutaneous strongyloidiasisB94.0 Sequelae of trachomaB95.0 Streptococcus, group A, as the cause of diseases classified

elsewhereB95.61 Methicillin susceptible Staphylococcus aureus infection as

the cause of diseases classified elsewhereB95.62 Methicillin resistant Staphylococcus aureus infection as the

cause of diseases classified elsewhereB95.8 Unspecified staphylococcus as the cause of diseases classified

elsewhereB96.20 Unspecified Escherichia coli [E. coli] as the cause of diseases

classified elsewhereB96.29 Other Escherichia coli [E. coli] as the cause of diseases

classified elsewhereB96.89 Other specified bacterial agents as the cause of diseases

classified elsewhereB97.35 Human immunodeficiency virus, type 2 [HIV 2] as the cause of

diseases classified elsewhereC00.0 Malignant neoplasm of external upper lipC00.1 Malignant neoplasm of external lower lipC00.2 Malignant neoplasm of external lip, unspecified

498 © 2019 The Coding Institute

ICD-10 CrossRef DetailsCoders’ Specialty Guide 2020: Ophthalmology/OptometryIC

D-1

0 C

ro

ssr

ef D

eta

Ils

C00

.3 —

C34

.2C00.3 — C34.2

C00.3 Malignant neoplasm of upper lip, inner aspectC00.4 Malignant neoplasm of lower lip, inner aspectC00.5 Malignant neoplasm of lip, unspecified, inner aspectC00.6 Malignant neoplasm of commissure of lip, unspecifiedC00.8 Malignant neoplasm of overlapping sites of lipC00.9 Malignant neoplasm of lip, unspecifiedC01 Malignant neoplasm of base of tongueC02.0 Malignant neoplasm of dorsal surface of tongueC02.1 Malignant neoplasm of border of tongueC02.2 Malignant neoplasm of ventral surface of tongueC02.4 Malignant neoplasm of lingual tonsilC02.8 Malignant neoplasm of overlapping sites of tongueC02.9 Malignant neoplasm of tongue, unspecifiedC03.0 Malignant neoplasm of upper gumC03.1 Malignant neoplasm of lower gumC03.9 Malignant neoplasm of gum, unspecifiedC04.0 Malignant neoplasm of anterior floor of mouthC04.1 Malignant neoplasm of lateral floor of mouthC04.8 Malignant neoplasm of overlapping sites of floor of mouthC05.0 Malignant neoplasm of hard palateC05.1 Malignant neoplasm of soft palateC05.2 Malignant neoplasm of uvulaC06.0 Malignant neoplasm of cheek mucosaC06.1 Malignant neoplasm of vestibule of mouthC06.2 Malignant neoplasm of retromolar areaC06.80 Malignant neoplasm of overlapping sites of unspecified parts

of mouthC06.89 Malignant neoplasm of overlapping sites of other parts of

mouthC06.9 Malignant neoplasm of mouth, unspecifiedC07 Malignant neoplasm of parotid glandC08.0 Malignant neoplasm of submandibular glandC08.1 Malignant neoplasm of sublingual glandC08.9 Malignant neoplasm of major salivary gland, unspecifiedC09.0 Malignant neoplasm of tonsillar fossaC09.8 Malignant neoplasm of overlapping sites of tonsilC09.9 Malignant neoplasm of tonsil, unspecifiedC10.0 Malignant neoplasm of valleculaC10.1 Malignant neoplasm of anterior surface of epiglottisC10.2 Malignant neoplasm of lateral wall of oropharynxC10.3 Malignant neoplasm of posterior wall of oropharynxC10.4 Malignant neoplasm of branchial cleftC10.8 Malignant neoplasm of overlapping sites of oropharynxC10.9 Malignant neoplasm of oropharynx, unspecifiedC11.0 Malignant neoplasm of superior wall of nasopharynxC11.2 Malignant neoplasm of lateral wall of nasopharynxC11.3 Malignant neoplasm of anterior wall of nasopharynxC11.8 Malignant neoplasm of overlapping sites of nasopharynxC11.9 Malignant neoplasm of nasopharynx, unspecifiedC12 Malignant neoplasm of pyriform sinusC13.0 Malignant neoplasm of postcricoid regionC13.1 Malignant neoplasm of aryepiglottic fold, hypopharyngeal

aspectC13.2 Malignant neoplasm of posterior wall of hypopharynxC13.8 Malignant neoplasm of overlapping sites of hypopharynxC13.9 Malignant neoplasm of hypopharynx, unspecifiedC14.0 Malignant neoplasm of pharynx, unspecifiedC14.2 Malignant neoplasm of Waldeyer's ringC14.8 Malignant neoplasm of overlapping sites of lip, oral cavity

and pharynxC15.3 Malignant neoplasm of upper third of esophagusC15.4 Malignant neoplasm of middle third of esophagusC15.5 Malignant neoplasm of lower third of esophagusC15.8 Malignant neoplasm of overlapping sites of esophagusC15.9 Malignant neoplasm of esophagus, unspecifiedC16.0 Malignant neoplasm of cardiaC16.2 Malignant neoplasm of body of stomachC16.3 Malignant neoplasm of pyloric antrumC16.4 Malignant neoplasm of pylorusC16.5 Malignant neoplasm of lesser curvature of stomach,

unspecified

C16.6 Malignant neoplasm of greater curvature of stomach, unspecified

C16.8 Malignant neoplasm of overlapping sites of stomachC16.9 Malignant neoplasm of stomach, unspecifiedC17.1 Malignant neoplasm of jejunumC17.2 Malignant neoplasm of ileumC17.3 Meckel's diverticulum, malignantC17.8 Malignant neoplasm of overlapping sites of small intestineC17.9 Malignant neoplasm of small intestine, unspecifiedC18.1 Malignant neoplasm of appendixC18.2 Malignant neoplasm of ascending colonC18.3 Malignant neoplasm of hepatic flexureC18.4 Malignant neoplasm of transverse colonC18.5 Malignant neoplasm of splenic flexureC18.6 Malignant neoplasm of descending colonC18.7 Malignant neoplasm of sigmoid colonC18.8 Malignant neoplasm of overlapping sites of colonC18.9 Malignant neoplasm of colon, unspecifiedC19 Malignant neoplasm of rectosigmoid junctionC20 Malignant neoplasm of rectumC21.0 Malignant neoplasm of anus, unspecifiedC21.1 Malignant neoplasm of anal canalC21.2 Malignant neoplasm of cloacogenic zoneC21.8 Malignant neoplasm of overlapping sites of rectum, anus and

anal canalC22.0 Liver cell carcinomaC22.1 Intrahepatic bile duct carcinomaC22.2 HepatoblastomaC22.3 Angiosarcoma of liverC22.4 Other sarcomas of liverC22.7 Other specified carcinomas of liverC22.8 Malignant neoplasm of liver, primary, unspecified as to typeC22.9 Malignant neoplasm of liver, not specified as primary or

secondaryC23 Malignant neoplasm of gallbladderC24.0 Malignant neoplasm of extrahepatic bile ductC24.1 Malignant neoplasm of ampulla of VaterC24.8 Malignant neoplasm of overlapping sites of biliary tractC24.9 Malignant neoplasm of biliary tract, unspecifiedC25.0 Malignant neoplasm of head of pancreasC25.1 Malignant neoplasm of body of pancreasC25.2 Malignant neoplasm of tail of pancreasC25.3 Malignant neoplasm of pancreatic ductC25.4 Malignant neoplasm of endocrine pancreasC25.9 Malignant neoplasm of pancreas, unspecifiedC26.0 Malignant neoplasm of intestinal tract, part unspecifiedC26.1 Malignant neoplasm of spleenC26.9 Malignant neoplasm of ill-defined sites within the digestive

systemC30.0 Malignant neoplasm of nasal cavityC30.1 Malignant neoplasm of middle earC31.0 Malignant neoplasm of maxillary sinusC31.1 Malignant neoplasm of ethmoidal sinusC31.2 Malignant neoplasm of frontal sinusC31.3 Malignant neoplasm of sphenoid sinusC31.8 Malignant neoplasm of overlapping sites of accessory sinusesC31.9 Malignant neoplasm of accessory sinus, unspecifiedC32.0 Malignant neoplasm of glottisC32.1 Malignant neoplasm of supraglottisC32.2 Malignant neoplasm of subglottisC32.3 Malignant neoplasm of laryngeal cartilageC32.8 Malignant neoplasm of overlapping sites of larynxC32.9 Malignant neoplasm of larynx, unspecifiedC33 Malignant neoplasm of tracheaC34.00 Malignant neoplasm of unspecified main bronchusC34.01 Malignant neoplasm of right main bronchusC34.02 Malignant neoplasm of left main bronchusC34.10 Malignant neoplasm of upper lobe, unspecified bronchus or

lungC34.11 Malignant neoplasm of upper lobe, right bronchus or lungC34.12 Malignant neoplasm of upper lobe, left bronchus or lungC34.2 Malignant neoplasm of middle lobe, bronchus or lung

591© 2019 The Coding Institute

Mo

difier

defin

ition

s22 —

Ai


Modifier DefinitionsModifier description

CPt® Modifiers

22 Increased Procedural Services

23 Unusual Anesthesia

24 Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period

25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

26 Professional Component

27 Multiple Outpatient Hospital E/M Encounters on the Same Date

32 Mandated Services

33 Preventive Services

47 Anesthesia by Surgeon

50 Bilateral Procedure

51 Multiple Procedures

52 Reduced Services

53 Discontinued Procedure

54 Surgical Care Only

55 Postoperative Management Only

56 Preoperative Management Only

57 Decision for Surgery

58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

59 Distinct Procedural Service

62 Two Surgeons

63 Procedure Performed on Infants less than 4 kg

66 Surgical Team

73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia

74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia

76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional

77 Repeat Procedure by Another Physician or Other Qualified Health Care Professional

78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period

Modifier description

79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

80 Assistant Surgeon

81 Minimum Assistant Surgeon

82 Assistant Surgeon (when qualified resident surgeon not available)

90 Reference (Outside) Laboratory

91 Repeat Clinical Diagnostic Laboratory Test

92 Alternative Laboratory Platform Testing

95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System

96 Habilitative Services

97 Rehabilitative Services

99 Multiple Modifiers

Category ii Modifiers

1P Performance Measure Exclusion Modifier due to Medical Reasons

2P Performance Measure Exclusion Modifier due to Patient Reasons

3P Performance Measure Exclusion Modifier due to System Reasons

8P Performance Measure Reporting Modifier, Action Not Performed, Reason Not Otherwise Specified

HCPCs Modifiers

A1 Dressing for one wound

A2 Dressing for two wounds

A3 Dressing for three wounds

A4 Dressing for four wounds

A5 Dressing for five wounds

A6 Dressing for six wounds

A7 Dressing for seven wounds

A8 Dressing for eight wounds

A9 Dressing for nine or more wounds

AA Anesthesia services performed personally by anesthesiologist

Ad Medical supervision by a physician: more than four concurrent anesthesia procedures

Ae Registered dietician

Af Specialty physician

AG Primary physician

AH Clinical psychologist

Ai Principal physician of record

592 © 2019 The Coding Institute

Modifier DefinitionsCoders’ Specialty Guide 2020: Ophthalmology/OptometryM

od

ifie

r d

efin

itio

ns

AJ

— e

BAJ — eB



AJ Clinical social worker

AK Non participating physician

AM Physician, team member service

Ao Alternate payment method declined by provider of service

AP Determination of refractive state was not performed in the course of diagnostic ophthalmological examination

AQ Physician providing a service in an unlisted health professional shortage area (HPSA)

Ar Physician provider services in a physician scarcity area

As Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery

At Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942)

AU Item furnished in conjunction with a urological, ostomy, or tracheostomy supply

AV Item furnished in conjunction with a prosthetic device, prosthetic or orthotic

AW Item furnished in conjunction with a surgical dressing

AX Item furnished in conjunction with dialysis services

AY Item or service furnished to an ESRD patient that is not for the treatment of ESRD

AZ Physician providing a service in a dental health professional shortage area for the purpose of an electronic health record incentive payment

BA Item furnished in conjunction with parenteral enteral nutrition (PEN) services

BL Special acquisition of blood and blood products

Bo Orally administered nutrition, not by feeding tube

BP The beneficiary has been informed of the purchase and rental options and has elected to purchase the item

Br The beneficiary has been informed of the purchase and rental options and has elected to rent the item

BU The beneficiary has been informed of the purchase and rental options and after 30 days has not informed the supplier of his/her decision

CA Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission

CB Service ordered by a renal dialysis facility (RDF) physician as part of the ESRD beneficiary’s dialysis benefit, is not part of the composite rate, and is separately reimbursable

CC Procedure code change (use ‘CC’ when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed)


Cd AMCC test has been ordered by an ESRD facility or MCP physician that is part of the composite rate and is not separately billable

Ce AMCC test has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity

Cf AMCC test has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable

CG Policy criteria applied

CH 0 percent impaired, limited or restricted

Ci At least 1 percent but less than 20 percent impaired, limited or restricted

CJ At least 20 percent but less than 40 percent impaired, limited or restricted

CK At least 40 percent but less than 60 percent impaired, limited or restricted

CL At least 60 percent but less than 80 percent impaired, limited or restricted

CM At least 80 percent but less than 100 percent impaired, limited or restricted

Cn 100 percent impaired, limited or restricted

Co Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant

CQ Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant

Cr Catastrophe/disaster related

Cs Item or service related, in whole or in part, to an illness, injury, or condition that was caused by or exacerbated by the effects, direct or indirect, of the 2010 oil spill in the Gulf of Mexico, including but not limited to subsequent clean-up activities

Ct Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) XR-29-2013 standard

dA* Oral health assessment by a licensed health professional other than a dentist

e1 Upper left, eyelid

e2 Lower left, eyelid

e3 Upper right, eyelid

e4 Lower right, eyelid

eA Erythropoietic stimulating agent (ESA) administered to treat anemia due to anti-cancer chemotherapy

eB Erythropoietic stimulating agent (ESA) administered to treat anemia due to anti-cancer radiotherapy

*This modifier is not included in 2020 HCPCS Modifier list, but it also has not been deleted. Please check the CMS website for further updates.

601

Term

ino

log

yA

b extern

o —

An

terior syn

echiae


Terminology Terms Definition

Ab externo The term means outside the eye; indicates the procedure of surgery starting from the eye’s exterior and proceeding to the anterior chamber.

Ablation Removal of a body part or organ or destruction of its function.

Abscess A collection of pus in a walled off sac or pocket, the result of infection.

Actinic keratoses Rough, scaly patches of skin that develop from prolonged exposure to sun.

Acute A medical condition or injury of sudden onset, sometimes severe in nature, and typically last a short period of time; opposite of chronic.

Adhesions Fibrous bands, which typically result from inflammation or injury during surgery, that form between tissues and organs; they may be thought of as internal scar tissue.

Age-related macular degeneration, or AmD

Weakening of the central area of the retina called the macula; AMD leads to vision loss in people age 50 or older.

Allergenic extract A protein containing an extract purified from a substance to which a patient may be allergic.

Allograft A tissue graft harvested from one person for another; donors include cadavers and living individuals related or unrelated to the recipient; also called allogeneic graft and homograft.

Amblyogenic developmental stage

Phase during early visual development in which the visual system is at risk to develop abnormal vision.

Amblyopia Decreased vision due to a disconnect between the eye and the brain.

Amniograft Using the amniotic membrane from a caesarean section to replace or repair defective tissue.

Amniotic membrane Inside of placenta in which the fetus develops.

Anastomosis Connection between two structures, anatomical or surgically created, such as between two blood vessels or the colon after resection of a part; types of anastomoses include end to side and side to side.

Anatomic topography Study of regions or divisions of the body and determining the relationship between various structures in that region.

Anesthesia A medication that reduces or eliminates sensitivity to pain; local or regional anesthesia reduce sensation to pain in specific areas of the body.

Angiography An X-ray study of the blood vessels that help providers diagnoses and treat medical conditions; angiography uses a radiopaque substance, called dye, to make the blood vessels visible under X-ray.

Angle closure glaucoma Type of glaucoma where the pressure inside the eye rises quickly because the drainage canals get blocked or covered over; also known as acute glaucoma or narrow angle glaucoma.

Angle width Area of vision at a particular point of view.

Anomaloscope Instrument used to test for color blindness.

Anterior Closer to the front part of the body or a structure.

Anterior chamber The space in the anterior or front segment of the eye, between the cornea, that focuses incoming light, and the iris, the colored ring membrane around the pupil; contains a clear liquid called aqueous humor.

Anterior chamber of eye The space between the cornea and the iris, filled with the aqueous humor and communicating through the pupil with the posterior chamber.

Anterior hyaloid membrane Tissue that separates the front portion of the vitreous, a gelatinous material, from the lens.

Anterior lamellar Disc present in the front of the eye.

Anterior lamellar keratoplasty

Technique for partial thickness corneal transplantation that preserves endothelial cells after removing all or part of the stroma, resulting in a less thick but uniform residual bed.

Anterior limiting lamina Tissue layer in the cornea between the outer layer and the stroma, also known as Bowman’s layer.

Anterior segment of the eye The forward one third of the eye that resides in front of the lens, filled with a clear liquid called aqueous humor; divided into anterior and posterior chambers connected by the pupil.

Anterior synechiae Adhesion between the iris and the cornea.

602

TerminologyCoders’ Specialty Guide 2020: Ophthalmology/OptometryTe

rm

ino

log

yA

nti

bio

tic

— B

loo

d c

lot

Antibiotic — Blood clot


Terms Definition

Antibiotic Substance that inhibits infection.

Anticoagulant A drug that prevents clot formation within the blood vessels and dissolves any blood clot formed previously.

Antifibrotic agents Drugs preventing fibrosis.

Aphakia The lens of the eye is not present, preventing the ability to adjust focus between objects at different distances.

Aqueous fluid, or humor Thick watery substance filling the space between the lens and the cornea.

Aqueous humor Clear fluid in the anterior chamber of the eye that fills up the space between the lens and the cornea; provides cushion effect.

Aqueous outflow canal Network through which aqueous humor flows.

Aqueous shunt An apparatus that the provider implants to control intraocular pressure in the anterior chamber of the eye by allowing aqueous fluid to drain from the anterior chamber.

Artificial lens Also called an intraocular lens, which is implanted in the eye of a patient who has had a cataract removed or to replace a damaged natural lens.

Aspirate Small amount of cells or fluid from a cyst or mass.

Aspiration Removal of fluid, gas, or other material through a tube attached to a suction device, often combined with irrigation; the instillation of fluid to wash out a cavity, such as the abdomen or stomach, or to clean a wound; also withdrawal of material, often with a needle; can also refer to breathing in fluid or food material.

Astigmatism Condition in which the cornea improperly focuses an image onto the innermost tunic of eyeball.

Autogenous graft Tissue harvested from the patient’s own body used to replace diseased, damaged, or missing tissue.

Autograft A tissue graft harvested from another location in the patient’s own body.

Autologous fascial sling Fascial tissue harvested from the patient’s own body, shaped into a sling, or strap and used to connect one structure closely to another.

Automated refraction Use of an instrument that calculates the amount of correction necessary in an eyeglass prescription.

Avascular Lacking blood supply.

Axial length Distance between the front third of the eye and the back two thirds of the eyeball.

Balanced salt solution A solution containing various salts that matches the pH and salt concentration in the body.

Bandage contact lens Lens which protects the cornea after surgery, allowing it to heal.

Banked fascia Fascia, fatty or fibrous connective tissue, from a donor source, typically from a cadaver, or deceased person.

Basal cell carcinoma (BCC) of the skin

The most common type of skin cancer; it arises from uncontrolled multiplication of basal cells in the deepest layer of the dermis; light-skinned and older individuals are at greater trisk for developing BCC; BCC rarely metastaticizes, but it can be invasive and aggressive.

Benign Not malignant, generally treatable or not needing treatment.

Bilateral On both the sides of the body.

Binocular indirect ophthalmoscopy

An investigation to view through a dilated pupil the internal surface of the hollow eye cavity, in indirect ophthalmoscopy the machine produces an inverted image of the fundus of the eye.

Biometry Biological measurements.

Biomicroscope Scope used to examine the structures of the eye.

Biopsy This is a medical technique to collect small amount of sample of abnormal cells or tissues from the affected site in order to diagnose the disease or to confirm the normality.

Blepharoplasty The surgical removal of excess of fat, muscle, and loose skin around the eyelids.

Blepharoptosis Drooping of the upper eyelid.

Blepharospasm Spontaneous automatic firm closing of the eyelids, or twitching, which is not under ones voluntary control.

Blepharotomy Surgical incision of the eyelid.

Blood clot End product of coagulation, the process that changes liquid blood to a gel.

623

Co

de In

dex

0100T — 67312


Codes Page no.

0100T 418

0191T 418

0198T 419

0207T 419

0253T 420

+0290T 420

0308T 421

0329T 422

0330T 422

0333T 422

0341T 423

0356T 423

+0376T 424

0378T 425

0379T 425

0380T 426

0402T 426

0444T 427

0445T 428

0449T 429

+0450T 430

0464T 430

0469T 431

0470T 431

+0471T 432

0472T 433

0473T 433

0474T 434

0506T 435

0507T 436

0509T 436

+0514T 437

+10004 5

10005 5

+10006 6

10007 6

+10008 7

10009 8

+10010 8

10011 9

+10012 9

Codes Page no.

10021 10

11640 12

65091 13

65093 13

65101 14

65103 15

65105 16

65110 17

65112 18

65114 19

65125 20

65130 21

65135 22

65140 22

65150 23

65155 24

65175 25

65205 26

65210 27

65220 28

65222 28

65235 29

65260 30

65265 31

65270 32

65272 33

65273 34

65275 35

65280 36

65285 36

65286 37

65290 38

65400 39

65410 40

65420 41

65426 42

65430 43

65435 44

65436 44

65450 45

65600 46

Codes Page no.

65710 47

65730 48

65750 49

65755 50

65756 51

+65757 52

65760 52

65765 53

65767 54

65770 54

65771 55

65772 56

65775 57

65778 59

65779 59

65780 60

65781 62

65782 63

65785 63

65800 64

65810 65

65815 66

65820 66

65850 67

65855 68

65860 69

65865 70

65870 71

65875 72

65880 73

65900 74

65920 75

65930 76

66020 77

66030 78

66130 79

66150 79

66155 80

66160 81

66170 83

66172 84

Codes Page no.

66174 85

66175 85

66179 86

66180 87

66183 88

66184 89

66185 90

66225 90

66250 91

66500 92

66505 93

66600 94

66605 95

66625 95

66630 97

66635 98

66680 99

66682 99

66700 100

66710 101

66711 102

66720 103

66740 104

66761 105

66762 106

66770 107

66820 108

66821 108

66825 109

66830 110

66840 111

66850 112

66852 113

66920 115

66930 116

66940 117

66982 118

66983 118

66984 120

66985 121

66986 122

Codes Page no.

+66990 123

66999 124

67005 124

67010 125

67015 126

67025 127

67027 128

67028 129

67030 131

67031 131

67036 133

67039 134

67040 136

67041 137

67042 138

67043 140

67101 141

67105 142

67107 143

67108 145

67110 146

67113 147

67115 148

67120 149

67121 150

67141 151

67145 152

67208 154

67210 155

67218 157

67220 158

67221 159

+67225 160

67227 161

67228 162

67229 163

67250 165

67255 166

67299 167

67311 167

67312 168

Code Index

$189.95

ISBN: 978-1-63527-680-0

eBook ISBN: 978-1-63527-698-59 781635 276800

The Coding Institute (TCI)

2222 Sedwick Road, Durham, NC 27713Phone: 1-800-508-2582 • Fax: 1-800-508-2592

Email: [email protected]: www.codinginstitute.com

Providing Simple Solutions for Success in HealthcareRely on TCI’s expert advice and guidance for all of your coding, billing, reimbursement, compliance,

and management needs.

MEDICAL CODING BOOKS

2020 HCPCS Level II Advisor

2020 Procedural Coding Advisor

2020 Procedural Reference Guide for Coders

2020 ICD-10-CM for Physicians & Hospitals

2020 ICD-10-PCS Complete Code Set

TOP SELLERS

Clinical Documentation Sourcebook

HIPAA Handbook

Practice Management Handbook

Master Denials Management & Appeals

Coding for Medical Necessity

Nonphysician Practitioner Handbook

Telemedicine Telehealth Handbook for Medical Practices

The Physician Practice Compliance Sourcebook

Evaluation and Management Coding Handbook

Coders’ Dictionary & Sourcebook

ILLUSTRATED SERIES: Coders’ Specialty Guides 2020 – Available in 22 specialties

Cardiology/Cardiothoracic Surgery

Dermatology/Plastics

Emergency Medicine

Family Practice/Primary Care

Gastroenterology

General Surgery, Vols. 1&2

Internal Medicine/Endocrinology/Wound Care

Neurology/Neurosurgery

Obstetrics & Gynecology

Oncology/Hematology

Ophthalmology/Optometry

Orthopedics, Vols. 1&2

Otolaryngology/Allergy

Pain Management

Pathology/Laboratory

Pediatrics

Physical/Occupational/Speech Therapy

Podiatry

Pulmonology

Radiology

Urology/Nephrology

Vascular Surgery

conjunctiva · 2019-11-28 · conjunctiva and tenon's capsule as possible. he removes the eye...

Documents