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.
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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
CPT® is a registered trademark of the American Medical Association. CPT © 2019 American Medical Association. All rights reserved.
Eye and Ocular AdnexaCoders’ Specialty Guide 2020: Ophthalmology/Optometryey
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6510
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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.
15Modifier: 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
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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.
16 Modifier: 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 AdnexaCoders’ Specialty Guide 2020: Ophthalmology/Optometryey
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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
17Modifier: 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
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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
18 Modifier: 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 AdnexaCoders’ Specialty Guide 2020: Ophthalmology/Optometryey
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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
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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
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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
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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
CPT® is a registered trademark of the American Medical Association. CPT © 2019 American Medical Association. All rights reserved.
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
CPT® is a registered trademark of the American Medical Association. CPT © 2019 American Medical Association. All rights reserved.
Modifier description
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)
Modifier description
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
© 2019 The Coding Institute
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
© 2019 The Coding Institute
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
© 2019 The Coding Institute
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
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