Sample page. Ophthalmology A comprehensive illustrated guide to coding and reimbursement CODING COMPANION

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1 CODING COMPANION 2018 Ophthalmology A comprehensive illustrated guide to coding and reimbursement POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.

2 Contents Getting Started with Coding Companion...i General Integumentary/Skin... 1 Introduction... 9 Repair Head Arteries and Veins Extracranial Nerves...39 Eyeball Anterior Segment Posterior Segment Ocular Adnexa Conjunctiva Operating Microscope Medicine Services HCPCS Appendix Correct Coding Initiative Update Evaluation and Management Codes Index Contents i

3 Getting Started with Coding Companion is designed to be a guide to the specialty procedures classified in the CPT book. It is structured to help coders understand procedures and translate physician narrative into correct CPT codes by combining many clinical resources into one, easy-to-use source book. The book also allows coders to validate the intended code selection by providing an easy-to-understand explanation of the procedure and associated conditions or indications for performing the various procedures. As a result, data quality and reimbursement will be improved by providing code-specific clinical information and helpful tips regarding the coding of procedures. For ease of use, Coding Companion lists the CPT codes in ascending numeric order. Included in the code set are all surgery, radiology, laboratory, medicine, and evaluation and management (E/M) codes pertinent to the specialty. Each CPT code is followed by its official CPT code description. Resequencing of CPT Codes The American Medical Association (AMA) employs a resequenced numbering methodology. According to the AMA, there are instances where a new code is needed within an existing grouping of codes, but an unused code number is not available to keep the range sequential. In the instance where the existing codes were not changed or had only minimal changes, the AMA assigned a code out of numeric sequence with the other related codes being grouped together. The resequenced codes and their descriptions have been placed with their related codes, out of numeric sequence. CPT codes within the Optum360 Coding Companion series display in their resequenced order. Resequenced codes are enclosed in brackets for easy identification. ICD-10-CM Overall, the 10th revision goes into greater clinical detail than did ICD-9-CM and addresses information about previously classified diseases, as well as those diseases discovered since the last revision. Conditions are grouped with general epidemiological purposes and the evaluation of health care in mind. New features have been added, and conditions have been reorganized, although the format and conventions of the classification remain unchanged for the most part. Detailed Code Information One or more columns are dedicated to each procedure or service or to a series of similar procedures/services. Following the specific CPT code and its narrative, is a combination of features. A sample is shown on page ii. The black boxes with numbers in them correspond to the information on the page following the sample. Appendix Codes and Descriptions Some CPT codes are presented in a less comprehensive format in the appendix. The CPT codes appropriate to the specialty are included in the appendix with the official CPT code description. The codes are presented in numeric order, and each code is followed by an easy-to-understand lay description of the procedure. The codes in the appendix are presented in the following order: Category III Radiology Pathology and Laboratory Medicine Services Category II codes are not published in this book. Refer to the CPT book for code descriptions. CCI Edit Updates The Coding Companion series includes the list of codes from the official Centers for Medicare and Medicaid Services National Correct Coding Policy Manual for Part B Medicare Contractors that are considered to be an integral part of the comprehensive code or mutually exclusive of it and should not be reported separately. The codes in the Correct Coding Initiative (CCI) section are from version 22.3, the most current version available at press time. The CCI edits are located in a section at the back of the book. Optum360 maintains a website to accompany the Coding Companions series and posts updated CCI edits on this website so that current information is available before the next edition. The website address is The 2017 edition password is: SPEC17DLC. Please note that you should log in each quarter to ensure you receive the most current updates. An reminder will also be sent to you to let you know when the updates are available. Evaluation and Management This resource provides documentation guidelines and tables showing evaluation and management (E/M) codes for different levels of care. The components that should be considered when selecting an E/M code are also indicated. Index A comprehensive index is provided for easy access to the codes. The index entries have several axes. A code can be looked up by its procedural name or by the diagnoses commonly associated with it. Codes are also indexed anatomically. For example: Transmastoid antrotomy (simple mastoidectomy) could be found in the index under the following main terms: Antrotomy Transmastoid, Excision Mastoid Simple, General Guidelines Providers The AMA advises coders that while a particular service or procedure may be assigned to a specific section, the service or procedure itself is not limited to use only by that specialty group (see paragraphs two and three under Instructions for Use of the CPT Codebook on page xii of the CPT Book). Additionally, the procedures and services listed throughout the book are for use by any qualified physician or other qualified health care professional or entity (e.g., hospitals, laboratories, or home health agencies). Keep in mind that there may be other policies or guidance that can affect who may report a specific service. Supplies Some payers may allow physicians to separately report drugs and other supplies when reporting the place of service as office or other nonfacility setting. Drugs and supplies are to be reported by the facility only when performed in a facility setting. Professional and Technical Component Radiology and some pathology codes have a technical and a professional component. When physicians do not own their own equipment and send their patients to outside testing facilities, they should append modifier 26 to the procedural code to indicate they performed only the professional component. Getting Started with Coding Companion i

4 Anterior Segment Radial keratotomy Explanation The cornea is one of several structures in the eye that contributes to refraction. Altering the shape of the cornea therefore alters visual acuity. The physician retracts the patient's eyelids with an ocular speculum and measures the patient's cornea. The physician places multiple nonpenetrating cuts in the cornea in a bicycle spoke on the patient's cornea to reduce myopia, or a variety of peripheral cornea tangential cuts for astigmatic correction. There are two basic surgical approaches: Russian, in which the incisions are made from the edges to the center of the cornea; and American, in which the incisions are made from the center to the periphery. The number and length of the incisions depend upon the patient's age and degree of myopia. The resulting change in the corneal curvature alters the refractive properties of the cornea to correct the preexisting refractive error. The speculum is removed. Antibiotic ointment and a pressure patch may be applied. Coding Tips Because the correction of a refractive error is usually not done out of medical necessity, the patient may be responsible for charges. Verify with the insurance carrier for coverage. This procedure is generally performed with a subconjunctival or retrobulbar injection rather than general anesthesia. Do not report in conjunction with for computerized corneal topography. Surgical trays, A4550, are not separately reimbursed by Medicare; however, other third-party payers may cover them. Check with the specific payer to determine coverage. ICD-10-CM Diagnostic Codes H52.10 H52.11 H52.12 H52.13 H H H Myopia, unspecified eye Myopia, right eye Myopia, left eye Myopia, bilateral Unspecified astigmatism, right eye Unspecified astigmatism, left eye Unspecified astigmatism, bilateral H Unspecified astigmatism, unspecified eye H Irregular astigmatism, right eye H Irregular astigmatism, left eye H Irregular astigmatism, bilateral H Irregular astigmatism, unspecified eye H Regular astigmatism, right eye H Regular astigmatism, left eye H Regular astigmatism, bilateral H Regular astigmatism, unspecified eye HCPCS Equivalent Codes Terms To Know astigmatism. Bending or diffusing of light rays in the eye that cannot be brought to a point of focus on the retina, due to unequal curvature on the refractive surface of the eye. cornea. Five-layered, transparent structure that forms the anterior or front part of the sclera of the eye. incision. Act of cutting into tissue or an organ. injection. Forcing a liquid substance into a body part such as a joint or muscle. limbus. Border of the cornea where it meets the sclera. medical necessity. Medically appropriate and necessary to meet basic health needs; consistent with the diagnosis or condition and national medical practice guidelines regarding type, frequency, and duration of treatment; rendered in a cost-effective manner. myopia. Defect in focusing in which the eye is overpowered and incoming distant light rays are focused in front of the retina because of a refractive or curvature defect in the lens. Malignant myopia is highly degenerative and complicated by serious disease of the choroid that leads to retinal detachment and blindness. ocular speculum. Instrument that holds the eyelids apart to give better access to the eyeball during a surgical procedure. peripheral. Outside of a structure or organ. retina. Layer of tissue located at the back of the eye that is sensitive to light similar to that of film in a camera. Medicare Edits Fac RVU 0.0 Non-Fac RVU 0.0 Modifiers FUD Status N MUE Medicare Reference None * with documentation - 78 Anterior Segment

5 Explanation Determination of refractive state The examiner determines the prescription required for the patient's eyeglasses or contact lenses by evaluating the effectiveness of a series of lenses through which the patient is asked to view an eye chart. This is usually accomplished with a refractor, a device that contains a range of lens powers that can be quickly changed, allowing the patient to compare various combinations when viewing the eye chart. A prescription is issued; no fitting for eyeglasses or contact lenses occurs at this time. Coding Tips Code is not included in the general ophthalmological service and may be reported separately when performed. Determination of refractive states includes specification of lens type (monofocal, bifocal, other), lens power, axis, prism, absorptive factor, impact resistance, and other factors. Eye refractions are noncovered by Medicare. To report fitting of spectacles when the physician provides the service, see For ocular screening performed by instrument, see or Do not report with or ICD-10-CM Diagnostic Codes H52.01 H52.02 H52.03 H52.11 H52.12 H52.13 H H H H H H Hypermetropia, right eye Hypermetropia, left eye Hypermetropia, bilateral Myopia, right eye Myopia, left eye Myopia, bilateral Irregular astigmatism, right eye Irregular astigmatism, left eye Irregular astigmatism, bilateral Regular astigmatism, right eye Regular astigmatism, left eye Regular astigmatism, bilateral H52.31 H52.32 H52.4 H H H H H H H H H H52.6 H H H H H H H53.11 H53.16 H53.19 H53.2 H53.31 H53.32 H53.33 H53.34 Z01.00 Z01.01 Anisometropia Aniseikonia Presbyopia Internal ophthalmoplegia (complete) (total), right eye Internal ophthalmoplegia (complete) (total), left eye Internal ophthalmoplegia (complete) (total), bilateral Paresis of accommodation, right eye Paresis of accommodation, left eye Paresis of accommodation, bilateral Spasm of accommodation, right eye Spasm of accommodation, left eye Spasm of accommodation, bilateral Other disorders of refraction Refractive amblyopia, right eye Refractive amblyopia, left eye Refractive amblyopia, bilateral Amblyopia suspect, right eye Amblyopia suspect, left eye Amblyopia suspect, bilateral Day blindness Psychophysical visual disturbances Other subjective visual disturbances Diplopia Abnormal retinal correspondence Fusion with defective stereopsis Simultaneous visual perception without fusion Suppression of binocular vision Encounter for examination of eyes and vision without abnormal findings Encounter for examination of eyes and vision with abnormal findings HCPCS Equivalent Codes Medicare Edits Fac RVU Non-Fac RVU * with documentation 0.56 Modifiers FUD Status N MUE Medicare Reference None - Medicine Services Medicine Services 305