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CHAPTER 27 EYE, OCULAR ADNEXA, AUDITORY, AND OPERATING MICROSCOPE Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 1 Eye and Ocular Adnexa (65091-68899) • Terminology extremely important – Code descriptions often vary only slightly (Cont’d…) Figure: 27.1 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 2 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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 3 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.” Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 4 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/_____, 15261 15121 15260/_____) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 5 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: without slit lamp; 65222, foreign • 65220, foreign body removal ______ with slit lamp body removal ____ Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 6 Anterior Segment (65400-66999) • Includes: – Cornea – Anterior Chamber – Anterior Sclera – Iris, Ciliary Body – Lens – Intraocular Lens Procedures – Other Procedures Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 7 Cornea • Kerato _____plasty: Repair of cornea • 65710-65757 • Penetrating _________ keratoplasty: Full thickness of cornea removed – Replaced with donor cornea Absence of lens of eye • Aphakia: _______ artificial lens • Pseudophakia: Presence of ______ after cataract surgery Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 8 Anterior Chamber (65800-66030) • Paracentesis: Removal of fluid – Needle inserted into anterior chamber and fluid withdrawn • _________: Goniotomy Surgical procedure using goniolens to view eye (65820) – Usually for congenital glaucoma • Synechiae ________ (adhesions) – Posterior synechiae: Adhesions iris to lens ___ – Anterior synechiae: Adhesions iris to ______ cornea (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 9 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 10 Iris, Ciliary Body (66500-66770) • Iridectomy performed for removal of: – Lesion (66600) – Treatment of glaucoma ________ (66625, 66630) – Laser _____ iridotomy/iridectomy (66761) – Photocoagulation (66762) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 11 Lens (66820-66940) • Cataracts – Nuclear cataract: Most common • Center of lens (nucleus) • Due to aging process Cortical cataract: Forms in lens of cortex and extends outward – ______ • Common in diabetics – Subcapsular __________ cataract: Forms at back of lens • Assigned based on type of procedure performed – Intracapsular (ICCE) – Extracapsular (ECCE) (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 12 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 13 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 14 Extraocular Muscles (67311-67399) • Strabismus Surgery – Corrects 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 15 Eyelids (67700-67999) • Blepharotomy (67700) – Incision into eyelid for drainage of abscess • Blepharoplasty eyelid – Repair of _____ – Codes in Integumentary System (15820-15823) – Codes in Eye and Ocular Adnexa (67916, 67917, 67923, 67924) Figure: 27.3 • Selection of code depends on technique used for repair ________ Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 16 Eyelid Modifiers E1-E4 • E1—upper ___ left eyelid • E2—lower ___ left eyelid • E3—upper ____ right eyelid • E4—lower ____ right eyelid Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 17 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 • Operating Microscope (69990) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 18 Divisions of Auditory System Figure: 27.10 • External, middle, and internal ear Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 19 Auditory System • Further divisions on procedure: – Incision – Excision – Removal, e.g., foreign body – Repair – Other Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 20 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 21 Removal of Foreign Body • Based on with/without general ______ anesthesia – 69200, 69205 • Impacted cerumen (with instrumentation) – One ear – 69210 _____ – Both ears – 69210-50 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 22 Repair • Otoplasty – For protruding ears – May or may not decrease external ear size both ears – Add -50 for ____ Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 23 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) (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 24 Middle Ear (69400-69799) (…Cont’d) • Canalplasty – Reconstruction of _______ external auditory canal – Codes based on stenosis or congenital defect – Caution: Canalplasty bundled into some _____ ear repair codes middle • For example 69631-69646 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 25 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 (_________ transcanal ) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 26 Excision (69905-69915) • Labyrinthectomy • Incus and stapes are removed • Codes are based on approach ________ as: – Transcanal 69905 – Postauricular (behind ear) 69910 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 27 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 cochlea ______ Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 28 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) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 29 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 69990 _____ in addition to code 15758)” Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 30 Conclusion CHAPTER 27 EYE, OCULAR ADNEXA, AUDITORY, AND OPERATING MICROSCOPE Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 31