Medical Cding Certificatin Review Mdule 27 Eye, Ocular Adnexa, Auditry, and Operating Micrscpe 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
Medical Cding Certificatin Review Mdule 27 (cntinued) Eye, Ocular Adnexa, Auditry, and Operating Micrscpe 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 & Ocular Adnexa (65091 68899) Cdes frm this sectin are very similar in descriptin and vary accrding t apprach and anatmy; anterir r psterir, eyeball r adnexa. Eyeball (65091 65290) Remval f the eye Ocular implants Remval f freign bdy Laceratin repairs (wund repairs) Anterir Segment (65400 66999) 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 (66830 66990) 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
Medical Cding Certificatin Review Mdule 27 (cntinued) Eye, Ocular Adnexa, Auditry, and Operating Micrscpe 2013 Cding Alert! Cdes 65800, 66982, 66983, 66984, and 66985 cntain new r revised text. Cde 65805 has been deleted. Psterir Segment (67005 67299) Vitreus, retina, chrids, psterir sclera Prphylaxis cdes reprted nly nce during the treatment perid Ocular Adnexa (67311 67999) Extracular muscles, rbit, and eyelids Blephartmy Cde remval f skin lesin invlving the lid and margin frm the Integumentary System/Surgery sectin (11310 11313; 11440 11446; 11640 11646; and 17000 17004) Cde blepharplasty (repair f the eyelid) frm (15820 15823) 2013 Cding Alert! Cde 67810 has been revised and resequenced. Cnjunctiva (68020 68899) Incisin and drainage based n size Auditry System The auditry system allws us t hear. The ears receive sund waves thrugh receptr (receiving) cells which 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 Middle Ear Tympanic membrane (eardrum): membrane that separates the uter and middle ear; sund waves bunce ff the eardrum which causes it t vibrate Ossicle (bne): three small ear bnes 3
Medical Cding Certificatin Review Mdule 27 (cntinued) Eye, Ocular Adnexa, Auditry, and Operating Micrscpe 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 (69000 69979) Cdes frm this sectin are divided int subheadings: external ear, middle ear, and inner ear. External Ear (69000 69399) Incisin, excisin, remval, repair, and ther prcedures 69090 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 Middle Ear (69400 69799) Intrductin, excisin, repair, and ther prcedures Myringtmy: incisin int the tympanic membrane 4
Medical Cding Certificatin Review Mdule 27 (cntinued) Eye, Ocular Adnexa, Auditry, and Operating Micrscpe 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 (69801 69949) 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 (refer t: Natinal Cverage Determinatins Manual 50.3, effective April 4, 2005) Tempral Bne, Middle Fssa Apprach (69950 69979) 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: exclusin list in the ntes under the CPT subsectin Operating Micrscpe ) 5