EyeNet Magazine



   
 
Savvy Coder: Coding & Reimbursement

ASC Coding: Part 4—Site-of-Service Differential
By John M. Haley, MD, Evelyn Kelly, OCS, F. Hampton Roy, MD
Sue Vicchrilli, COT, OCS, and Trexler M. Topping, MD
 
 

Certain office-based services are subject to a facility-based reduction when performed in an ambulatory surgery center. This reduction applies only to services on the CMS list of ASC-covered services. From the “Eye and Ocular Adnexa” section of CPT, services that are subject to that site-of-service differential include the following:

Eyeball
65125  Modification of ocular implant with placement or replacement of pegs (e.g., drilling receptacle for prosthesis appendage), separate procedure

65205 Removal of foreign body, external eye; conjunctival superficial

65210  conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating

65220  corneal, without slit lamp

65222  corneal, with slit lamp

65270  Repair of laceration; conjunctiva, with or without nonperforating laceration sclera, direct closure

65272  conjunctiva, by mobilization and rearrangement, without hospitalization

65273  conjunctiva, by mobilization and rearrangement, with hospitalization

65275  cornea, nonperforating, with or without removal of foreign body

65286  application of tissue glue, wounds of cornea and/or sclera

Anterior Segment
65400  Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium

65410  Biopsy of cornea

65420  Excision or transportation of pterygium; without graft

65426  with graft

65430  Scraping of the cornea, diagnostic, for smear and/or culture

65435  Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage)

65436  with application of chelating agent (e.g., EDTA)

65450  Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization

65600  Multiple punctures of anterior cornea (e.g., for corneal erosion, tattoo)

65772  Corneal relaxing incision for correction of surgically induced astigmatism

65800  Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration of aqueous

65805  with therapeutic release of aqueous

65815  with removal of blood, with or without irrigation and/or air injection

65855  Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)

65860  Severing adhesions of anterior segment, laser technique (separate procedure)

66020  Injection, anterior chamber of eye (separate procedure); air or liquid

66030  Medication

66130  Excision of lesion, sclera

66250  Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure

66700  Ciliary body destruction; diathermy

66710  Cyclophotocoagulation, transscleral

66720  Cryotherapy

66740  Cyclodialysis

66761  Iridotomy/iridectomy by laser surgery, one or more sessions (e.g., for glaucoma)

66762  Iridoplasty by photocoagulation, one or more sessions (e.g., for improvement of vision for widening of anterior chamber angle)

66770  Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure)

66821  Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery, one or more stages (e.g., YAG laser) 

Posterior Segment
67025  Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)

67031  Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (one or more stages)

67101  Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid

67105  Photocoagulation, with or without drainage of subretinal fluid

67120  Removal of implanted material, posterior segment, extraocular

67141  Prophylaxis of retinal detachment (e.g., retinal break, lattice degeneration) without drainage, one or more sessions; cryotherapy, diathermy

67145  photocoagulation (laser or xenon arc)

67208  Destruction of localized lesion of retina (e.g., macular edema, tumors), one or more sessions; cryotherapy, diathermy

67210  photocoagulation

67220  Destruction of localized lesion of choroid (e.g., choroidal neovascularization); photocoagulation (e.g. laser), one or more sessions

67221  Photodynamic therapy (includes intravenous infusion)

67225  Photodynamic therapy, second eye, at single session (List separately in addition to code for primary eye treatment)

67227  Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions; cryotherapy, diathermy

About Us Academy Jobs Privacy Policy Contact Us Terms of Service Medical Disclaimer Site Index