• Jan. 1 CCI Edits Bundle Several Ophthalmology Codes


    Below are the NCCI edits, version 23.0, that impact ophthalmology effective Jan. 1, 2017. CPT codes in Column 2 are bundled with the CPT codes in with Column 1.

    The majority have an indicator of 1, which means the codes can be unbundled when the definition of modifier -59 or the new –X modifiers are met. Typically this means the procedures are performed in separate eyes. However several include the indicator of 0, which means these codes can never be unbundled.

    To see all CCI edits, the Academy provides a link to the CMS site at aao.org/coding.

    With the exception of add-on codes, all surgical procedure codes have a mutually exclusive edit with the following three new CPT codes for 2017:

    • 99155 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
    • 99156 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older
    • +99157 each additional 15 minutes intraservice time (List separately in addition to code for primary service).
    Column 1 Column 2 Indicator
    76510 Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter

    76970 Ultrasound study follow-up (specify)

    76998 Ultrasound guidance, intraoperative
    1
    76511 Ophthalmic ultrasound, diagnostic; quantitative A-scan only 76970 Ultrasound study follow-up (specify) 1
    76512 Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed nonquantitative A-scan) 76970 Ultrasound study follow-up (specify) 1
    76513 Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy 76970 Ultrasound study follow-up (specify) 1
    76514  Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)
    76970 Ultrasound study follow-up (specify)
    76998 Ultrasound guidance, intraoperative
    1
    76516 Ophthalmic biometry by ultrasound echography, A-scan 76970 Ultrasound study follow-up (specify) 1
    76519 Ophthalmic biometry by ultrasound echography, A -scan; with intraocular lens power calculation 76970 Ultrasound study follow-up (specify) 1
    76529 Ophthalmic ultrasonic foreign body localization 76970 Ultrasound study follow-up (specify) 1
    92240 Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral 92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral 0
    92242 Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral 92230 Fluorescein angioscopy with interpretation and report
    92250 Fundus photography with interpretation and report
    99211 Technician exam
    1
    92242 Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral 92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral 92240 Indocyanine-green angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral 0