Download chapter 27 eye, ocular adnexa, auditory, and operating

CHAPTER 27
EYE, OCULAR ADNEXA, AUDITORY,
AND OPERATING MICROSCOPE
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 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
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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…)
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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.”
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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
(15120/15121, 15260/15261)
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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:
• 65220, foreign body removal without slit lamp; 65222, foreign
body removal with slit lamp
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Slide 6
Anterior Segment
(65400-66999)
• Includes:
– Cornea
– Anterior Chamber
– Anterior Sclera
– Iris, Ciliary Body
– Lens
– Intraocular Lens Procedures
– Other Procedures
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Slide 7
Cornea
• Keratoplasty: Repair of cornea
• 65710-65757
• Penetrating keratoplasty: Full thickness of
cornea removed
– Replaced with donor cornea
• Aphakia: Absence of lens of eye
• Pseudophakia: Presence of artificial lens
after cataract surgery
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Slide 8
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withdrawn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 to lens
– Anterior synechiae: Adhesions iris to cornea
(Cont’d…)
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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
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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)
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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…)
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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
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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
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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
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Slide 15
Eyelids (67700-67999)
• Blepharotomy (67700)
– Incision into eyelid for
drainage of abscess
• Blepharoplasty
– Repair of eyelid
– 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
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Slide 16
Eyelid Modifiers E1-E4
• E1—upper left eyelid
• E2—lower left eyelid
• E3—upper right eyelid
• E4—lower right eyelid
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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)
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Slide 18
Divisions of Auditory System
Figure: 27.10
• External, middle, and internal ear
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Slide 19
Auditory System
• Further divisions on procedure:
– Incision
– Excision
– Removal, e.g., foreign body
– Repair
– Other
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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
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Slide 21
Removal of Foreign Body
• Based on with/without general anesthesia
– 69200, 69205
• Impacted cerumen
– One or both ears
– 69210
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Slide 22
Repair
• Otoplasty
– For protruding ears
– May or may not decrease external ear size
– Add -50 for both ears
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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…)
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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
middle ear repair codes
• For example 69631-69646
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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)
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Slide 26
Excision (69905-69915)
• Labyrinthectomy
• Incus and stapes are removed
• Codes are based on approach as:
– Transcanal 69905
– Postauricular (behind ear) 69910
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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
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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)
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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)”
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Slide 30
Conclusion
CHAPTER 27
EYE, OCULAR ADNEXA, AUDITORY,
AND OPERATING MICROSCOPE
Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc.
Slide 31