Chapter 13

Eye and Ocular Adnexa, Auditory Systems

Eye: Introduction and Anatomy

Eye Structures

Source: AAPC

The eyeball is composed of a tough membrane called sclera. This white outer skin of the eye is
covered with a thin protective layer of conjunctiva. Light first enters the eye through the cornea. The
cornea has five layers; sometimes corneal defects will be managed by removing one or two layers,
rather than full-thickness cornea. The cornea meets the sclera in a ring called the limbus, also known
as the sclerocorneal junction. Behind the cornea is the anterior segment of the eye, which is filled
with a clear, salty fluid called aqueous humor.

Next, light from the aqueous humor enters the crystalline lens, a convex disc suspended on threads
just behind the iris. The iris is a muscle that expands and contracts to regulate the amount of light
entering the posterior chamber of the eye through the pupil. If the light is too bright, the iris
expands so the size of the pupil shrinks. If there is too little light, the iris contracts to enlarge the
pupil and allow more light into the eye. The threads holding the lens and the ciliary body to which
they are connected automatically tug at the lens to change its shape to help focus on items near or
far.

After the light has been bent by the crystalline lens, it enters the vitreous humor, a gel-like mass that
fills the large posterior chamber of the eye. The vitreous humor presses against the inner layer of the
eye, maintaining the eyeball’s shape and keeping the blood-rich choroid layer in contact with the
retina. The light is placed upon the retina’s rods and cones like a projected image at a movie theater,
and these images are transmitted via the optic nerve to the brain.

The eyeball’s shape affects the way light is focused and directed (refraction). Any reduction in fluid
within the eye will affect the eye’s shape and refraction. For instance, if the eyeball is too oblong,
the patient will be nearsighted (myopia). In farsightedness (hyperopia), the eyeball is foreshortened,
and close-up vision is impaired.

Each eye has six muscles that direct the gaze up and down and from side to side.

To trace again the refraction path: Light travels from the cornea to the aqueous humor to the lens to
the vitreous humor to the retina. The eyeball’s stability and the refractive elements must all be
perfect for vision to be 20/20.

The lacrimal system produces tears in glands behind the eyebrows that flow through ducts into the
eyes then drain out the lacrimal puncta or flow into the nose.

The visual field can be affected by many things: Blood, foreign bodies (FBs), or other tissue can
obstruct the pathway to the retina. Examples include: excessive skin on the eyelids, shielding a
portion of the eye from light, a cloudy condition in any of the refractive properties of the eye, or
damage to the retina.
Ear: Introduction and Anatomy

Ear Structures

Source: AAPC

In the ear, conduction refers to the transfer of sound waves. Sound waves take two paths in
humans:

[Link] waves can be captured by the pinna, or outer ear, and travel by air along the external auditory
meatus to the tympanic membrane. The tympanic membrane vibrates to telegraph its message to
the middle ear, where the malleus picks up the vibration, and transfers it to the incus and stapes.
These three tiny bones, the ossicles, carry the message to the oval window and round window in the
vestibule of the inner ear and into the cochlea, where perilymph fluid vibrates and creates nerve
impulses to the cochlear nerve.

[Link] conduction is secondary to air conduction (above). The mastoid bones contain tiny air cells
that also form a conductive path for sound.

The ear is also a center for balance. Information within the vestibule and the three semicircular
canals is sent to the brain, signaling the body to compensate by adjusting to posture or movement as
appropriate for the orientation of the body.
The entry to the ear is well protected by the meaty exterior, and the ear canal is lined with hairs and
lubricated with cerumen to filter out FBs. To equalize the pressure between the middle ear and the
outer world, the Eustachian tubes link the middle ear to the nasopharynx.

Key Roots, Suffixes, Prefixes for Eye and Ear

acous/o

hearing

blephar/o

eyelid

canth/o

corner of eyelid

cochle/o

cochlear

conjunctiv/o

conjunctival

dacry/o

relating to lacrimal system, tear

dipl/o
two

goni/o

angle

irid/o

iris

kerat/o

corneal

myring/o

tympanic membrane

-opia

vision

ot/o

ear

phak/o

lens

phot/o
light

-ptosis

droop

retin/o

retinal

rhin/o

nose

scler/o

ocular sclera

staped/o

stapes

tars/o

margin of eyelid

trabecul/o

relating to meshwork for drainage of aqueous humor

uve/o

uveal

vitre/o

vitreous

ICD-10-CM Coding

The diagnostic codes for the eye and ear are found in multiple sections of ICD-10-CM. There are no
coding guidelines in ICD-10-CM specific to the ear, but an understanding of common disorders of
these organs can help you in selecting the correct codes. Although most eye codes are found in
Disorders of the Eye and Adnexa (H00-H59) and ear are found in Diseases of the Ear and Mastoid
Process (H60-H95), there are a significant number of diagnosis codes for these organs found in other
chapters of ICD-10-CM. To ensure the proper code is selected the search for a code always begins in
the ICD-10-CM Alphabetic Index.

Eye

Most eye disorders fall into these general categories:

Infection and inflammation

Neoplastic disease

Injury

Glaucoma

Cataracts

Retinopathy

Retinal detachment

Strabismus

Infection and inflammation—When the patient has an infection or inflammation, first determine the
location. The codes within Disorders of the Eye and Adnexa (H00-H59) are organized according to
laterality and anatomic site, beginning with globe, then moving from the posterior segment forward
to the anterior segment of the eye and finishing with the adnexa. The eyelids, lacrimal system, and
musculature follow. Some eye infections (for instance herpes zoster ocular disease, B02.3- or
trachoma, A71.-) are found in the Infectious and Parasitic Diseases chapter. Remember to report
secondarily the infectious agent, if known (for example, B95.62 for Methicillin Resistant
Staphylococcus Aureus (MRSA) infection as the cause of disease classified elsewhere).
Neoplastic disease—Codes for neoplasms are straightforward for the eye. Remember to begin in the
Alphabetic Index and move to the Table of Neoplasms, as directed. Do not only look for the entry
“Eye” in the Table of Neoplasms. Instead, look for the specific accessory organ or structure of the
eye. For example, there are separate entries for lacrimal canaliculi, duct, gland, punctum, and sac.

The retina is delicate and blood-rich, making it difficult to biopsy. Instead of a biopsy, the physician
will monitor the spot, sometimes called a retinal freckle. Report D49.81 Neoplasm of unspecified
behavior of retina and choroid for this condition.

Remember: Melanoma in situ of the eye is reported with codes other than malignant neoplasms of
the skin. In the Alphabetic Index look for Melanoma/in situ/eye. You are directed to D03.8
Melanoma in situ of other sites.

Injury—Most eye injury codes are found in the Injury and Poisoning chapter of ICD-10-CM; however,
acute toxic conjunctivitis (H10.21-) and corneal disorder due to a contact lens (H18.82-) are among
the exceptions. Superficial injury to the eye and adnexa is reported with codes from category S05, or
in the case of external eye foreign bodies (FB), T15. Open wounds of the eye are addressed in
category S01 and S05. For penetrating FBs in the eyeball, look for Puncture/eyeball in the Alphabetic
Index. Burns to the eye and adnexa are handled with category T26, with an additional code from
category T31 to identify the extent of the burn.

Injuries also can occur during eye surgery. Codes in the T80-T88 categories are used for Complication
of Surgical and Medical Care, not elsewhere classified. Codes from this category are used if there is a
mechanical complication, for example, T85.39- Other mechanical complication of other ocular
prosthetic devices, implants, and grafts, or T85.2- due to an intraocular lens (IOL). Intraoperative and
postprocedural complications of the eye and adnexa have surgery specific complications in category
H59. If cataract fragments remain in the eye following cataract surgery, see H59.02-.

Glaucoma—Too much pressure from fluid can lead to a hypertensive condition in the eye called
glaucoma. Glaucoma codes are covered in category H40, except for congenital glaucoma, which is
reported with code Q15.0.

Glaucoma is classified according to the type of angle closure. Acute angle closure would occur
quickly, for example, in the minutes or hours following an injury to the eye. Chronic angle closure
can be due to a defect that could be the result of illness or age. Glaucoma can occur with an open
angle, as well. Coding for glaucoma in ICD-10-CM is done with a combination code that includes the
type of glaucoma with the 7th character to indicate the stage.
Guidelines exist in ICD-10-CM specific to the glaucoma. Guidelines can be found in section I.C.7.a.1-
I.C.7.a-5. Different types of glaucoma can exist in different stages in both eyes at the same time.
Careful attention to the type of glaucoma and laterality is important for accurate coding.

There is a difference in glaucoma of indeterminate state and glaucoma of unspecified stage.

Indeterminate stage is assigned when the provider is not able to clinically determine the stage of
glaucoma; unspecified should be assigned when there is no documentation from the provider
related to the stage.

Cataracts—Cataracts describe flaws or clouds that develop in the crystalline lens, and are reported
with codes from category H26, unless congenital in origin (Q12.0). The lens has many layers, and
specific ICD-10-CM codes can be selected to identify cataracts by their layer.

Often, when a cataract is removed from the eye, the physician opts to retain the posterior
outermost shell so there remains an organic separation between the posterior and anterior
chambers. Later, this remaining shell may develop opacities as well, and this is called an “after-
cataract.” After-cataract is coded with H26.4-.

Retinopathy—Retinopathy describes changes that occur in the blood vessels within the retina. These
aneurysms, hemorrhages, and proliferation of small vessels damage the retina and put the patient’s
vision at risk.

Retinal detachment—Injury or anatomic defect can cause the retina to be freed from the blood-rich
choroid at the back of the eye. Corrective action might include the injection of fluid, air, or external
eye pressure to push the retina back into place, or bursts of laser to burn the retina to the choroid.

Strabismus—Coordinated eye movement is essential to depth perception, single vision, and other
aspects of sight. When the eyes do not move in synchrony, it is often because of misalignment of
mismatched strength in the eye muscles. Variations in strabismus are called “tropias”. In esotropia,
the eye deviates inward; in exotropia, it deviates outward. In hypertropia, the eye deviates upward;
and in hypotropia, it deviates downward. Balance is restored to the eyes by lengthening or
shortening muscle.

Ear

Most disorders of the ear fall into the following categories:

Infection and inflammation

Neoplastic disease
Injury

Vertigo

Hearing loss

Congenital disorders

Infection and inflammation—When the patient has an infection or inflammation, first determine the
location. The codes within Diseases of the Ear and Mastoid Process (H60-H95) are organized
according to anatomic site, beginning with the external ear, moving to the middle and inner ear, and
ending with codes describing hearing loss.

By far, the most common codes used in this chapter are the codes for otitis media (OM), or middle
ear infection.

Neoplastic disease—Acoustic neuroma, also called a vestibular schwannoma, is likely the most
common neoplasm related to the ear. The Table of Neoplasms has a fairly complete listing of
subcategory sites under subentry Ear. Always begin in the Alphabetic Index to ensure your code is
listed in the table.

Injury—Most ear injury codes are found in the Injury and Poisoning chapter of ICD-10-CM.

Vertigo—Vertigo usually is classified as being peripheral or central. Peripheral vertigo is caused by

disease in the inner ear. Central vertigo arises from brain pathology. Vertigo can be a symptom (R42)
or, if the cause is known, reported with a code from category H81. Ménière’s disease is the most
common form of peripheral vertigo, and often is accompanied by hearing loss and tinnitus, or
ringing in the ears. Vertigo also can cause nystagmus, or reflexive jerky eye movements.

Hearing loss—Conductive hearing loss originates in the continuity of sound transmission.

Sensorineural hearing loss occurs along the nerve conduction that begins in the cochlear nerve and
travels to the brain. Sometimes, there are mixed reasons for hearing loss.

Congenital disorders—Many chromosomal syndromes have ear anomalies as a component.

Typically, the individual anomaly being treated is reported in addition to the code for the syndrome
itself. Other syndromes occur with microtia, or less visible defects. A combination of codes from
Diseases of the Ear and Mastoid Process (H60-H95) and the congenital section for the ear (category
Q16-Q17) may be necessary to capture the clinical picture completely.

Symptoms and Z Codes

Z codes specific to the eye and ear include codes for family histories for blindness, deafness and
other anomalies, and personal histories of cornea, globe, and lens replacements. There are codes
identifying the reason for the encounter, such as fitting and adjustment of glasses, contacts or
hearing aids, issuance of prescriptions, or aftercare following plastic reconstruction. Other codes
report eye vision and hearing screening exams. Read the guidelines and notes carefully and refer to
the index as well for sequencing advice.

ACRONYMS

AACG

acute angle closure glaucoma

AC

anterior chamber

AMD

age related macular degeneration

CACG

chronic angle closure glaucoma

CE

cataract extraction

DA

dark adaptation
FA

fluorescein angiography

FB

foreign body

FTG

fulltime glasses

GDD

glaucoma drainage device

GP

gas permeable

IOL

intraocular lens

LL

lower lid

NLD

nasal lacrimal duct

OAG

open-angle glaucoma

OD

right eye

OS

AACG

acute angle closure glaucoma

AC

anterior chamber

AMD

age related macular degeneration

CACG

chronic angle closure glaucoma

CE

cataract extraction
DA

dark adaptation

FA

fluorescein angiography

FB

foreign body

FTG

fulltime glasses

GDD

glaucoma drainage device

GP

gas permeable

IOL

intraocular lens

LL

lower lid
NLD

nasal lacrimal duct

OAG

open-angle glaucoma

OD

right eye

OS

left eye

OU

both eyes

PCIOL

posterior chamber IOL

PMMA

polymethylmethacrylate

POAG
primary open angle glaucoma

PSC

posterior subcapsular cataract

RD

retinal detachment

RK

radial keratotomy

ROP

retinopathy of prematurity

TM

trabecular meshwork

VALE

visual acuity, left eye

VARE

visual acuity, right eye

WNL
within normal limits

CPT® Coding

Codes throughout the CPT® code book may be used to report procedures on the eye and ear. The
codes specific to Eye and Ocular Adnexa (65091–68899) and Auditory System (69000–69979), with a
few exceptions, are reported almost exclusively by specialists.

Eye

An eye typically is removed for one of three reasons: the eye has a malignancy; the eye is blind and
very painful; or the eye is blind and disfiguring.

There are three types of removals (65091–65114):

[Link]—The contents of the eyeball are scooped out, but the sclera shell remains connected
to the eye muscles, so the prosthesis, fitted into the globe, will have natural movement.

[Link]—The connections (muscles, vessels, and optic nerve) are severed and the entire
eyeball is removed en mass.

[Link]—Surrounding skin, fat, muscle, and bone are removed.

In any removal, a temporary implant may be placed to protect the void that may later hold a
permanent implant. This temporary implant is included in the procedure and not reported
separately. The implant codes reference permanent implants with aesthetic properties.

Today, whenever a laser can be used to surgically cauterize, cut, destroy, or repair the eye, it will be
used instead of a knife. When you are reviewing the codes in CPT®’s Eye and Ocular Adnexa section,
assume any procedure with a laser approach is preferred to an open approach.

Some surgeries require incisions. Removal of a lens with a cataract requires an incision, so the lens
can be extracted and an IOL inserted. Even so, cataract surgery is done microscopically today, and
tiny incisions in the limbus are all that is required.
Injections are sometimes required to numb the eye. A retrobulbar or Tenon’s capsule injection are
two common approaches for delivery of anesthetic. These nerve blocks are bundled into the
procedures and not reported separately.

Most procedures performed on the anterior segment of the eye are microsurgeries performed using
an operating microscope. The scope, otherwise reported with 69990, would not be reported
separately.

Surgeries on the iris and trabecular meshwork, including goniotomy, are usually a therapeutic
treatment for glaucoma to improve the flow of aqueous in the eye. Sometimes aqueous is removed
for therapy in paracentesis. This procedure also can be performed diagnostically.

There are many procedures performed on the ocular adnexa. The extraocular muscles may be
lengthened or shortened. In some cases, the procedure is not completed until the patient is
awakened and lengthy sutures extruding from the back of the eye adjusted to ensure perfect
binocular vision. These adjustable sutures are reported with add-on code +67335.

The eyelids and conjunctiva are included in the adnexal codes. In prosthetics following evisceration,
the conjunctiva may traverse an artificial cornea. When conjunctiva is damaged, buccal mucosa may
be harvested and used as a graft (68325). Procedures to remove excess skin from the eyelid
(blepharoplasty) are found in the integumentary chapter. Blepharoplasty codes in the Eye and
Adnexa section involve more complex structures within the eye.

Medicine Codes

Ophthalmology office visit codes focus entirely upon the eye. Follow closely the guidelines appearing
with these codes, 92002–92014, to determine whether evaluation and management (E/M) or
ophthalmology office visits are more appropriate.

In addition to the office visit codes, the Medicine section contains dozens of codes for special
ophthalmology tests and for services associated with dispensing contacts and spectacles.

Ear

Procedures for the ear are organized anatomically. Many of the external ear procedures are simple
procedures; for example, 69200 Removal foreign body from external auditory canal; without
anesthesia. The repair codes for external ear are often performed by plastic surgeons and relate to
defects that may be congenital or due to injury.
The middle ear begins at the tympanic membrane, and procedures from this point and beyond
usually are limited to specialists. The most common tympanic procedure is the placement of
ventilating tubes (69433 and 69436) to mitigate frequent middle ear infections. Codes 69420 and
69421 are for aspiration and/or eustachian tube inflation in which the tympanic membrane is cut to
allow drainage, but no tube is placed. The eustachian tube is anatomic structure connecting the
middle ear and the mouth which can be blocked and needs to be inflated to open it.

The mastoid process is also included in the middle ear. Mastoiditis can occur if a middle ear infection
goes untreated. Mastoidectomies may be performed, for instance, if the patient develops
cholesteatoma from chronic infection. The mastoid bone also may be removed to make room for a
cochlear implant. The middle ear also contains the ossicles, and surgeries may be performed to
repair the ossicular chain or address defects in the oval and round windows. None of the codes in
the Auditory System represent services that include use of an operating microscope, so 69990 would
be reported in addition to any procedure, if an operating microscope is used.

As with the eye, a section for auditory and vestibular testing is presented in the Medicine chapter of
CPT®. Most of the services represented in the Medicine chapter could be performed by ancillary
providers such as audiologists.

HCPCS Level II

HCPCS Level II codes report injectable or implantable drug supplies used in the treatment of ear and
eye disorders, as well as supplies of prostheses, visual aids, contact lenses, glasses, and hearing aids.

Glaucoma screening codes for ophthalmologists or optometrists participating in the Physician

Quality Reporting System (PQRS) are found in the temporary G codes (G0117 and G0118).

Many of the prosthetics and durable medical equipment (DME) reported through HCPCS Level II are
no longer distributed by physicians. Instead, they write prescriptions for these items. The most
important codes to consider as you study the HCPCS Level II codes for ophthalmic and ear, nose, and
throat (ENT) procedures are drug injection supplies. The Table of Drugs in your HCPCS Level II book
will list these alphabetically, so they are easy to locate. Always confirm your code choice in the
tabular section of your HCPCS Level II book.

Modifiers

Because the eyes and ears are bilateral organs, identifying a procedure as bilateral (50) or identifying
laterality (RT and LT) becomes very important to payment processes.
Another issue for payers is whether the patient has his own lens (phakic), an artificial lens
(pseudophakic), or no lens (aphakic). Aphakic patients may be eligible for benefits not available to
others; hence modifier VP.

Commonly used modifiers:

50

Bilateral procedure

E1

Upper left, eyelid

E2

Lower left, eyelid

E3

Upper right, eyelid

E4

Lower right, eyelid

LS

FDA monitored intraocular lens (IOL) implant

LT
Left

PL

Progressive addition lenses

RT

Right

VP

Aphakic patient

Glossary

Acoustic Neuroma—Benign tumor arising from cells of the auditory nerve, also called a vestibular
schwannoma.

After-cataract—Following cataract removal, the physician opts to retain the posterior outermost
shell, so an organic separation remains between the posterior and anterior chambers. This
remaining shell later may develop opacities called “after-cataract.”

Anterior Segment—Cornea up to the vitreous body, including the aqueous humor, iris, and lens.

Aqueous Humor—Clear fluid filling the area behind the cornea, in front of the iris.

Blepharoplasty—Surgical repair of the eyelid.

Cholesteatoma—Benign growth of skin in the middle ear; usually caused by chronic otitis media.

Cataract—Flaws or clouding in the crystalline lens.

Cerumen—Ear wax.

Choroid—Middle layer between the retina and the sclera in the eye’s posterior segment. The
choroid nourishes the retina.

Ciliary Body—Thickened layer of the vascular tunic. It contains the muscle that controls the shape of
the lens.

Cochlea—Inner ear structure shaped like a snail shell. It is divided into two canals and the organ of
Corti.

Conduction—Receptions or conveyance of sound, heat, or electricity. Sound waves are conducted to

the inner ear through bones in the skull.

Conjunctiva—Thin protective layer lining the eyelid and covering the sclera.

Cornea—“Bay window of the eye”. The cornea has five layers and they act to refract the light
entering the eye.

Crystalline Lens—Convex disc suspended on threads just behind the iris.

Dacryolith—Calculus on the lacrima.

Enucleation—Removal of a structure, such as the eyeball.

Esotropia—Ward deviation of the eye.

Eustachian Tube—Tube in the ear linking the middle ear to the nasopharynx. This tube equalizes
pressure between the middle ear and the outer atmosphere.

Evisceration—Procedure where the contents of the eyeball are removed, but the sclera shell
remains connected to the eye muscles, so a prosthesis fitted into the globe will have natural
movement.
Exenteration—Removal of a complete structure. Surrounding skin, fat, muscle, and bone are
removed.

External Auditory Meatus—Pathway from the pinna (outer ear) to the tympanic membrane.

Exotropia—Outward deviation of the eye.

Glaucoma—Hypertensive condition of the eye caused by too much pressure from fluid.

Goniotomy—Procedure where an opening is made in the trabecular meshwork of the front part of
the eye. The provider uses a goniolens during the procedure.

Hypertropia—Upward deviation of the eye.

Incus—Tiny bone (ossicle) in the middle ear.

Iris—Muscular ring around the pupil that regulates the amount of light that enters the pupil; it is the
source of eye color.

Limbus—Ring where the cornea meets the sclera; also known as the sclerocorneal junction.

Malleus—Tiny bone (ossicle) in the middle ear that picks up vibration from the tympanic membrane.

Mastoiditis—Inflammation or infection of the mastoid bone.

Ménière’s Disease—Most common form of peripheral vertigo, caused by dilation of the lymphatic
channel of the cochlea and accompanied by hearing loss and tinnitus.

Nystagmus—Reflexive jerky eye movements as a response to the messages of the inner ear.

Microtia—Congenital deformity of the ear.

Optic Nerve—Nerve that transmits images from the eye to the brain. Damage to the optic nerve can
result in loss of or impaired vision.
Ossicles—Three tiny bones of the middle ear.

Otitis Media—Middle ear infection.

Oval Window—Membrane-covered window from the inner ear to the middle ear.

Perilymph—Fluid in the cochlea that vibrates and creates nerve impulses to the cochlear nerve.

Puncta—Tiny openings of the tear ducts.

Pupil—Opening of the eye’s center where light enters.

Mastoid—Bone in the skull just behind the ear containing tiny air cells that also form a conductive
path for sound.

Refraction—Focus and direction of light.

Retina—Layer of tissue in the back of the eye that is light sensitive.

Retinal Detachment—Retina is freed from the blood-rich choroid at the back of the eye. When the
retinal layer floats away, it loses its supply of nutrients. Nutrients must be returned, or vision is lost.

Retrobulbar—Space behind the eye.

Round Window—Membrane-covered window from the inner ear to the middle ear.

Sclera—White outer skin of the eye that’s covered with a thin protective layer of conjunctiva.

Sclerocorneal Junction—Ring where the cornea meets the sclera, also known as the limbus.

Semicircular Canals—Three tiny tubes in the inner ear, filled with fluid to assist in balance.
Stapes—Tiny bone (ossicle) in the middle ear.

Strabismus—Improper alignment of the eyes.

Tenon’s Capsule—Connective tissue surrounding the posterior eyeball.

Trachoma—Bacterial infection of the eyes.

Tympanic Membrane—Thin, delicate tissue separating the outer ear from the inner ear.

Vestibule—Inner part of the ear that connects the semicircular canals and the cochlea. The vestibule
contains the sense organs responsible for balance.

Vestibular Schwannoma—Benign tumor arising from nerve cells of the auditory nerve, also called
acoustic neuroma.

Vertigo—Dizziness resulting in the loss of balance.

Visual Field—Total area that can be seen by peripheral vision.

Vitreous Humor—Gel-like mass that fills the large posterior chamber of the eye.

Chapter Review Questions

[Link] is a retrobulbar injection delivered?

[Link]

[Link]

[Link]
[Link]

[Link] are cataracts?

A.A defect in the management of intraocular pressure

[Link] or other defects in the lens of the eye

[Link] of abnormal vessels at the back of the eye

D.A drooping of eyelids that occurs with age

[Link] patient has a significant category 1 low visual impairment due to regular astigmatism in the
left eye. It is corrected with glasses. The right eye has normal vision. Code the patient’s diagnosis
code(s) based on this information.

A.H52.222

B.H52.222, H54.52A1

C.H52.202, H54.62

D.H54.52A1, H52.202

4.A patient with a left tympanic membrane tear arrives for a left lateral graft tympanoplasty with the
use of an operating microscope. What procedure and diagnosis codes are reported?

A.69631, H72.02

B.69641, H72.02
C.69631, 69990, H72.92

D.69641, 69990, H72.92

5.A 2 year old arrives at the emergency department (ED) crying, tugging and holding her ear. After
examination, the physician determines there is a small plastic toy piece lodged in the external
auditory canal and removes it using small forceps. What is the procedure code for this service?

A.69105

B.69110

C.69200

D.69205

[Link] multiple orbital operations, fibrous adhesions formed between the extraocular muscle and
the orbital contents on the walls of the orbital cavity itself. The surgeon releases extensive scar
tissue without detaching the extraocular muscle. What CPT® coding is reported for the procedure?

A.67318

B.67311, 67331

C.67343

D.67343, 67332

7.A patient with a history of persistent serous otitis media presents to have tubes placed in her ears.
The patient was brought to the operating room (OR), given a general anesthetic with a bag and
mask. The ear canals were inspected. A tympanostomy incision was made in the anterior inferior
quadrant in a radial incision. A small amount of serous fluid was found in the middle ear space on
both sides. An Armstrong grommet ventilation tube was placed in both ears with alligator forceps
and suctioned clear. TobraDex drops were placed through the PE tube in each ear.
The correct coding for this procedure is:

A.69631-50

B.69433-50

C.69641-50

D.69436-50

8.A patient with bilateral, upper-eyelid ptosis and bilateral, upper-eyelid blepharochalasis arrives for
upper-eyelid ptosis repair, via external approach using the levator aponeurosis plication technique,
both eyes, and upper-eyelid blepharoplasties, both eyes. The upper eyelids were injected with
approximately 3 cc each of a ½ and ½ mixture of Xylocaine 2 percent with epinephrine and Marcaine
0.5 percent with epinephrine. The physician then cut along the pre-marked lines and excised a
skin/muscle flap. The orbital septum was identified and opened, and any herniating orbital fat was
removed. The levator aponeurosis was identified and two horizontal mattress 6-0 silk sutures were
placed through the mid-upper tarsus and the levator aponeurosis. The patient was sat upright to
elevate the lid height and contour. The patient was then repositioned, and re-approximation of the
skin and orbicularis was accomplished using interrupted 6-0 silk sutures, bilaterally.

What CPT® coding is reported?

A.67904-E1, 67904-E3, 15822-E1, 15822-E3

B.67904-E1, 67901-E3, 15823

C.67903-50

D.67904-E1, 67904-E3, 15823-E1, 15823-E3

[Link] Report
Preoperative Diagnosis: Ruptured globe, full thickness corneal laceration, right eye

Postoperative Diagnosis: Ruptured globe, full thickness corneal laceration, right eye

Operation: Surgical repair of ruptured globe, surgical repair of full thickness corneal laceration, right
eye

Operative Procedure: The patient was brought to the operating theater and properly positioned. The
patient was subsequently prepped and draped in the usual sterile fashion. A lid speculum was placed
in the patient’s operative right eye. Fluorescein was used to delineate the evidence of the patient’s
wound leakage. A diamond blade and 0.12 forceps were used to make a temporal paracentesis port.
Nonpreserved lidocaine was injected into the anterior chamber as well as BSS. Two interrupted 10-0
nylon sutures were used to close the corneal laceration. Fluorescein was used to test the wound
which showed no evidence of wound leak. Gentamicin 0.5 mL and Dexamethasone 0.5 mL were
injected subconjunctivally. Tobradex ointment was placed in the patient’s operative eye. The lid
speculum was removed from the patient’s operative eye. The patient tolerated the procedure well
without apparent complications and went to the recovery room in good condition.

Prognosis: Immediate and remote good specimen sent to lab: None

Complications: None

What CPT® and ICD-10-CM codes are reported for this procedure?

[Link] Report

Preoperative Diagnosis: Bilateral serous otitis media

Postoperative Diagnosis: Bilateral serous otitis media

Operative Technique: The patient has a history of persistent chronic serous otitis media, unimproved
with aggressive antibiotic therapy over the past six months.

The patient was brought to the OR, given a general anesthetic with a bag and mask. The ear canals
were inspected. A tympanostomy incision was made in the anterior inferior quadrant in a radial
incision. A small amount of serous fluid was found in the middle ear space on both sides. An
Armstrong grommet ventilation tube was placed in both ears with alligator forceps and suctioned
clear. TobraDex drops were placed through the PE tube in each ear.

The patient was sent to the recovery room in good condition, discharged with a TobraDex drop
prescription for two days and will follow-up in the office in two weeks.

What CPT® and ICD-10-CM codes are reported for this procedure?