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CHAPTER 22

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  1. CHAPTER 22 EYE, OCULAR ADNEXA, AUDITORY, AND OPERATING MICROSCOPE

  2. Eye and Ocular Adnexa (65091-68899) • Terminology extremely important • Code descriptions often vary only slightly (Cont’d…) Figure: 22.1

  3. Eye and Ocular Adnexa (65091-68899) (…Cont’d) • Codes divided anatomically, examples: • Eyeball • Conjunctiva • Anterior Segment • Posterior Segment • Ocular Adnexa • Some codes specifically for patients previously operated on (Cont’d…)

  4. Eye and Ocular Adnexa (65091-68899) (…Cont’d) • Much bundling • Example: Subheading Posterior Segment, Prophylaxis category notes indicate • “The following descriptors intended to include all sessions in defined treatment period.”

  5. Eyeball (65091-65290) • Removal of the Eye report: • Evisceration (65091, 65093) • Removal of contents of globe • Enucleation (65101-65105) • Removal of eye, leaving orbital structures intact • Exenteration(65110-65114) • Removal of eye, adnexa, part of bony orbit • Associated skin grafting reported separately (15120/15121, 15260/15261)

  6. Removal of Foreign Body (65205-65265) • Extensive notes • Removal from external or intraocular • Slit lamp • Microscope with high-intensity light source • Focuses long narrow beam of light • Different codes for with/without slit lamp • Example: • 65220, foreign body removal without slit lamp; 65222, foreign body removal withslit lamp

  7. Anterior Segment (65400-66999) • Includes: • Cornea • Anterior Chamber • Anterior Sclera • Iris, Ciliary Body • Lens • Intraocular Lens Procedures • Other Procedures

  8. Cornea • Keratoplasty: Repair of cornea • 65710-65756 • Penetrating keratoplasty: Full thickness of cornea removed • Replaced with donor cornea • Aphakia: Absenceof lens of eye • Pseudophakia: Presence of artificial lens after cataract surgery

  9. Anterior Chamber (65800-66030) • Paracentesis: Removal of fluid • Needle inserted into anterior chamber and fluid withdrawn • Diagnostic (65800) • Therapeutic (65805-65815) • Goniotomy: Surgical procedure using goniolens to view eye (65820) • Usually for congenital glaucoma • Synechiae (adhesions) • Posterior synechiae: Adhesions iris tolens • Anterior synechiae: Adhesions iris to cornea

  10. Anterior Chamber (65800-66030) (…Cont’d) • Trabeculectomy ab externo (e.g., 65850) • Involves trabecular meshwork • Iris-scleral junction, drains aqueous humor • Surgery reshapes or punctures the meshwork as a treatment for glaucoma or trauma

  11. Iris, Ciliary Body (66500-66770) • Iridotomy performed for removal of: • Lesion (66600) • Treatment of glaucoma (66625, 66630) • Laser iridotomy (66761) • Photocoagulation (66762)

  12. Lens (66820-66940) • Cataracts • Nuclear cataract: Most common • Center of lens (nucleus) • Due to aging process • Corticalcataract: Forms in lens of cortex and extends outward • Common in diabetics • Subcapsularcataract: Forms at back of lens • Assigned based on type of procedure performed • Intracapsular (ICCE) • Extracapsular (ECCE) (Cont’d…)

  13. Lens (…Cont’d) • Removal and lens placement (66830-66990) • Extracapsular cataract extraction(ECCE), partial removal • Removes hard nucleus in 1 piece and soft cortex in multiple pieces • Intracapsular cataract extraction (ICCE), total removal • Removes lens and capsule in 1 piece • Phacoemulsification • Small incision into eye, introduction of probe • High frequency waves fragment cataract • Lens placed through same small incision

  14. Posterior Segment (67005-67229) • Codes include: • Vitreous procedures for removal of vitreous humor from the eye • Repair of retinal detachment • Destruction lesion of retina or choroid

  15. Extraocular Muscles(67311-67399) • Strabismus Surgery • Connects muscle misalignment • Horizontal muscles (67311-67312) • Move the eye side to side • Vertical muscles (67314-67316) • Move the eye up and down • Codes are divided by the type of repair and number of muscles repaired

  16. Eyelid (67700-67999) • Blepharotomy (67700) • Incision into eyelid for drainage of abscess • Blepharoplasty • Repair ofeyelid • Codes in Integumentary System (15820-15823) • Codes in Eye and Ocular Adnexa (67916, 67917, 67923, 67924) • Selection of code depends on techniqueused for repair Figure: 22.3

  17. Eyelid Modifiers • E1-E4 • E1—upper left eyelid • E2—lower left eyelid • E3—upper right eyelid • E4—lower right eyelid

  18. Auditory System (69000-69979) • Codes divided by • External Ear (69000-69399) • Middle Ear (69400-69799) • Internal Ear (69801-69949) • Temporal Bone, Middle Fossa Approach (69950-69979) • Outer and middle ear function is conduction of sound waves through the ear • Inner ear contains structures that receive the auditory waves and relay them to the brain • Right ear—AD • Left ear—AS • Both ears—AU • Operating Microscope (69990)

  19. Divisions of Auditory System Figure: 22.10 • External, middle, and internal ear

  20. Auditory System • Further divisions on procedure: • Incision • Excision • Removal, e.g., foreign body • Repair • Other

  21. External Ear (69000-69399) • Incision: Drainage of abscess or hematoma • Simple, 69000 • Complicated, 69005 • Excision: Biopsy • External ear, 69100 • External auditory canal, 69105 • Excision of external ear, partial/complete, 69110, 69120

  22. Removal of Foreign Body • Based on with/withoutgeneral anesthesia • 69200, 69205 • Impacted cerumen • One or both ears • 69210

  23. Repair • Otoplasty • For protruding ears • May or may not decrease external ear size • Add -50 for both ears

  24. Middle Ear (69400-69799) • Eustachian tube connects middle ear to back of throat for drainage • Fluid collects in middle ear when tube malfunctions • Prevents air from entering middle ear and pressure builds • Surgical intervention • Myringotomy (incision into tympanic membrane) relieve pressure and drain pus • Tympanostomy (incision and placement of PE tube (pressure equalization) repair of eardrum and hearing mechanism • Myringotomy included in a tympanostomy (tubes)

  25. Middle Ear (69400-69799) • Canalplasty • Reconstruction of external auditory canal • Codes based on stenosis or congenital defect • Caution: Canalplasty bundled into some middle ear repair codes • For example 69631-69646

  26. Inner Ear, Incision and/or Destruction (69801-69840) • Labyrinthotomy: Surgical incision into the cavelike structure (labyrinth) of inner ear • If pressure builds within labyrinth, may result in: • Vertigo • Ringing • Hearing loss, etc. • 69801, 69802 = with/withoutmastoidectomy

  27. Excision (69905-69915) • Labyrinthectomy • Incus and stapes are removed • Codes are based on approach as: • Transcanal 69905 • Postauricular (behind ear) 69910

  28. Introduction (69930) • Cochlear device Implant • Computerized device • Restores partial hearing • Receiver on outside of skin, behind ear, over the site of transmitter • Transmitter implanted under skin • Sound processor connected to an electrode implanted in cochlear

  29. Temporal Bone, Middle Fossa Approach (69950-69979) • Surgical approach used with: • Repair vestibular labyrinth nerves (69950) • Decompress facial nerve (69955) • Decompress internal auditory canal (69960) • Removal of neoplasm from temporal bone (69970)

  30. Operating Microscope (+69990) • Used with procedures using microsurgical techniques • Code in addition to primary procedure performed • Unless primary procedure description includes microsurgical techniques • Example: 15758 Free fascial flap with microvascular anastomosis • Note that following 15758 is the statement: • “(Do not report code 69990in addition to code 15758)”

  31. ConclusionCHAPTER 22 EYE, OCULAR ADNEXA, AUDITORY, AND OPERATING MICROSCOPE