The eyes and the ocular adnexa (adjoining parts) are sense organs that allow us to see (vision) (sight).

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1 Mdule 27 The eyes and the cular adnexa (adjining parts) are sense rgans that allw us t see (visin) (sight). Anatmy f the Eye Eye The eye is a rund-shaped rgan cmpsed f three layers called tunica (cat). 1. Fibrus Tunic (Outer) Outer layer f the eye; prtective cver; cnsists f the sclera and crnea Sclera: white f the eye Crnea: frnt f the sclera; transparent; lies ver the iris 2. Vascular Tunic (Middle) Middle layer f the eye; als knwn as the uvea; cnsists f the chrids, iris, and ciliary bdy Chrids: vascular area; bld supply t the entire eye Iris: clred membrane surrunding the pupil Ciliary bdy: circular muscle; allws the eye t fcus thrugh accmmdatin 3. Sensry Tunic (Inner) Delicate inner layer f the eye; cnsists f the retina Retina: thin, delicate nerve cell layer f the eye; cntains rds and cnes (pht receptrs) Cnes: phtreceptr; clr and central visin Rds: phtreceptr; lw light, night visin, and peripheral visin Cnjunctiva: delicate membrane that lines the inside f the eyelids Lacrimal glands: tear ducts Refractin: bending back; the crnea bends the light rays, allwing the retina t fcus Accmmdatin: eye muscle cntracts and relaxes, causing changes in the size f the lens, allwing the eye t fcus Diseases and Cnditins Astigmatism: defect in visin; usually hrizntally r vertically Cataract: cluding n the lens f the eye; causes decreased visin; cmplicatin f diabetes Chalazin: granulma (hard cyst) n the eyelid; may require incisin and drainage (I & D) Cnjunctivitis: inflammatin f the cnjunctiva (pink eye) 1

2 Mdule 27 (cntinued) Diabetic retinpathy: disease f the retina due t diabetes mellitus Glaucma: damage t the retina with lss f visin; due t excessive intracular pressure; diagnsed by tnmetry; may be treated by laser therapy r iridtmy (incisin f the iris) Hrdelum: stye; inflammatin due t infectin f the sebaceus gland Hyperpia: farsightedness Mypia: nearsightedness Presbypia: lss f visin due t age Ptsis: drping r aging eyelids Retinal detachment: separatin f the tw layers f the retina; requires surgical repair (retinpexy) Strabismus: abnrmal deviatins f the eye (crss-eyed) Surgery/Eye and Ocular Adnexa ( ) Cdes frm this sectin are very similar in descriptin and vary accrding t apprach and anatmy; anterir r psterir, eyeball r adnexa. Eyeball ( ) Remval f the eye Ocular implants Remval f freign bdy Laceratin repairs (wund repairs) Anterir Segment ( ) Crnea, anterir chamber, sclera, iris, ciliary bdy, lens, and intracular lens prcedures Excisin, bipsy, remval, and destructin Keratplasty includes fresh r preserved grafts Paracentesis (aspiratin f fluids r ducts) Cataracts are cded based n type, apprach, r methd ( ) Nuclear cataract: mst cmmn due t aging; center f the lens Crtical cataract: cmmn in diabetics; in the crtex Subcapsular: back f the lens Cde supply separately (99070) fr intracular lens prsthesis Cde ultrasund guidance separately 2

3 Mdule 27 (cntinued) 2014 Cde Alert! Cdes and have been revised. Cde has been added. Psterir Segment ( ) Vitreus, retina, chrids, psterir sclera Prphylaxis cdes reprted nly nce during the treatment perid Ocular Adnexa ( ) Extracular muscles, rbit, and eyelids Blephartmy Cde remval f skin lesin invlving the lid and margin frm the Surgery / Integumentary System sectin ( ; ; ; and ) Cde blepharplasty (repair f the eyelid) frm Cnjunctiva ( ) Incisin and drainage based n size Auditry System The auditry system allws us t hear. The ears receive sund waves thrugh receptr (receiving) cells, and the sund waves are then transmitted (sent) by nerve fibers t the cerebral crtex f the brain. Anatmy The ear (t/) is divided int three areas: uter ear, middle ear, and inner ear. Outer Ear Pinna (auricle): uter flap f the ear; sund waves enter Auditry meatus (auditry canal): leads frm the utside f the ear t the middle ear Cerumen: yellw wax substance that lines, prtects, and lubricates the auditry canal 3

4 Mdule 27 (cntinued) Middle Ear Tympanic membrane (eardrum): membrane that separates the uter and middle ear; sund waves bunce ff the eardrum, which causes it t vibrate Ossicles (bnes): three small ear bnes 1. Malleus: first bne f the middle ear 2. Incus: secnd bne f the middle ear 3. Stapes: third bne f the middle ear Eustachian tubes: tubes that cnnect the middle ear with the naspharynx Inner Ear (Labyrinth) Oval windw: separates the middle ear frm the inner ear Cchlea: snail-shaped bny structure; sund travels in lymph cells Organ f Crti: receiving area within the cchlea Diseases and Cnditins Deafness: inability t hear; hearing lss Otitis externa (swimmer s ear): caused by bacteria r fungus; excessive expsure t water Otitis media: inflammatin f the middle ear (ear infectin) Acute titis media: sudden nset ften fllwing a cld r upper respiratry infectin (URI) Suppurative titis media: bacterial ear infectin (pus) Serus titis media: fluid in the ears causing inflammatin (n infectin) Vertig: dizziness caused by an imbalance in equilibrium Tinnitus: ringing r buzzing in the ears; caused by irritatin t the cilia (hairs) f the inner ear Surgery/Auditry System ( ) Cdes frm this sectin are divided int subheadings: external ear, middle ear, and inner ear. External Ear ( ) Incisin, excisin, remval, repair, and ther prcedures Ear piercing (elective prcedure nt cvered by insurance) Remval f freign bdies with r withut general anesthesia Repair: tplasty fr prtruding ears (69300) includes mderate sedatin Use mdifier -50 fr bilateral tplasty 2014 Cde Alert! Cde has been revised. 4

5 Mdule 27 (cntinued) Middle Ear ( ) Intrductin, incisin, excisin, repair, and ther prcedures Myringtmy: incisin int the tympanic membrane Tympanstmy: surgical incisin t create an pening; incisin and placement f PE tubes PE tubes (pressure equalizatin): small plastic tubes that allw fluid t drain; may fall ut naturally r be remved later by surgery Use mdifier -50 fr bilateral prcedures (bth ears) Wrd Parts Review -tmy means incisin, t cut -stmy means surgical creatin f an pening Memrizatin Tip: there is n S in cut! Tympanstmy is ne f the mst cmmn surgical prcedures perfrmed n children in the U.S. Accrding t the American Academy f Pediatrics, it is the mst cmmn reasn fr a child t underg general anesthesia in the U.S. Tubes are an integral part f the surgery and cannt be billed fr separately using a supply cde. Inner Ear ( ) Incisin and/r destructin, excisin, intrductin, and ther prcedures Labyrinthtmy: incisin f the labyrinth (inner ear) Cchlear device implantatin (implanted hearing device): perfrmed t restre hearing t the hearing impaired; CPT cde (69930); HCPCS cde fr device (L8614); special cverage instructins Tempral Bne, Middle Fssa Apprach ( ) Operating Micrscpe (69990) Add-n cde nly (D nt cde alne) D nt use mdifier -51 n this cde D nt reprt this cde when it is an integral part f a primary prcedure (see the exclusin list in the ntes) 5

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