CCI 8.1 Update:
Most New Edits Allow Unbundling with Modifier -59
Published on Wed May 01, 2002
The Correct Coding Initiative (CCI) version 8.1, effective April 1 to June 30, 2002, contains many bundling edits for ophthalmology. However, most allow unbundling if modifier -59 (Distinct procedural service) conditions are met. The following codes allow unbundling:
Code 66820 (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]); stab incision technique [Ziegler or Wheeler knife]) now includes 66500-66682, the entire set of incision, excision, and repair codes for the iris and ciliary body.
Code 66821 ( laser surgery [e.g., YAG laser] [one or more stages]) now includes 66500-66682.
Code 66825 (Repositioning of intraocular lens prosthesis, requiring an incision [separate procedure]) now includes 66500-66682.
Code 66830 (Removal of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid] with corneo-scleral section, with or without iridectomy [iridocapsulotomy, iridocapsulectomy]) now includes 66500-66635 (incision and excision procedures for the iris and ciliary body) and 67715* (Canthotomy [separate procedure]).
Codes 66840 (Removal of lens material; aspiration technique, one or more stages), 66850 ( phacofragmen-tation technique [mechanical or ultrasonic] [e.g., phacoemulsification], with aspiration), 66852 ( pars plana approach, with or without vitrectomy), 66920 ( intracapsular), 66930 ( intracapsular, for dislocated lens), 66940 ( extracapsular [other than 66840, 66850, 66852]), and 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis [one stage procedure]) now include 66500-66635, 66820-66821 and 67715.
Code 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex, requiring devices or techniques not generally used in routine cataract surgery [e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis] or performed on patients in the amblyogenic developmental stage) now includes 66505 and 67715.
Code 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]) now includes 66505, 66605, 66630, 66635 and 67715.
Code 66986 (Exchange of intraocular lens) now includes 66820 and 66821.
Code 67036 (Vitrectomy, mechanical, pars plana approach) now includes 67221.
Code 67039 ( with focal endolaser photocoagu-lation) now includes 67221 and 67225, as well as HCPCS codes G0186 and G0187.
Code 67040 ( with endolaser panretinal photoco-agulation) now includes 67221, 67225, G0186 and G0187.
Code 67101 (Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid) now includes G0185.
Code 67105 ( photocoagulation, with or without drainage of subretinal fluid) now includes 67221, 67225, G0186 and G0187.
Codes 67107 (Repair of retinal detachment; scleral buckling [such as lamellar scleral dissection, imbrication or encircling procedure], with or without implant, with or without cryotherapy, photocoagulation, and drainage of subretinal fluid) and 67108 ( with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique) now include 67221, 67225, G0185, G0186 and G0187.
Code 67112 ( by scleral buckling or vitrectomy, on patient having previous ipsilateral retinal detachment repair[s] using scleral buckling or vitrectomy techniques) now includes 67221.
Codes 67350 (
Biopsy of extraocular muscle), 67415 (
Fine needle aspiration of orbital contents), 67810* (
Biopsy of eyelid), 68100 (
Biopsy of conjunctiva), 68510 (
Biopsy of lacrimal gland) and 68525 (
Biopsy of lacrimal sac) now include fine needle aspiration codes 10021 and 10022.
Two codes allow unbundling with all but 69990 (operating microscope):
Code 67221 (Destruction of localized lesion of choroid [e.g., choroidal neovascularization]; photodynamic therapy [includes intravenous infusion]) now includes intravenous and venous procedure codes 36000, 36400 and 36425; it also includes 67005-67015, 67145, 67500, 69990, +96570 and +96571.
New add-on code 67225 (
photodynamic therapy, second eye, at single session [list separately in addition to code for primary eye treatment]) includes 36400, 36410, 36425, 67005-67015, 67145, 67500, 69990, 90780 and 90784.
Unbundling is never allowed with two codes:
Code 76506 (Echoencephalography, B-scan and/or real time with image documentation [gray scale] [for determination of ventricular size, delineation of cerebral contents and detection of fluid masses or other intracranial abnormalities], including A-mode encephalography as secondary component where indicated) now includes ophthalmic ultrasound codes 76511 and 76512.
Code 76512 (Ophthalmic ultrasound, echography, diagnostic; contact B-scan [with or without simultaneous A-scan]) now includes 76511.
