• January 2019 CCI Edits Impact New Biopsy CPT Codes


    The Centers for Medicare and Medicaid Services (CMS) is scheduled to implement its current Correct Coding Initiative Edits (CCI), Version 25.0 effective Jan. 1, 2019.

    The table below includes several new ophthalmic codes this year and lists how the edits impact billing. Indicator 1 states that there are times when it is appropriate to unbundle. Indicator 0 states these two codes can never be unbundled.

    To see all CCI edits, the Academy provides a link to the CMS site on the coding updates and resources page. You can also find current edits in the Coding Coach print and online.

    Column 1 Column 2 Bundling Edit
    11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion

    11104 Punch biopsy of skin (including simple closure, when performed); single lesion

    11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion
    12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5cm or less
    12013 ;2.6cm to 5.0cm
    12014 ;5.1cm to 7.5cm
    12015 ;7.6cm to 12.5cm
    12016 ;12.6cm to 20.0cm
    12017 ;20.1cm to 30.0cm
    12018 ;over 30.1cm

    12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less
    12052 ;2.6cm to 5.0cm
    12053 ;5.1cm to 7.5cm
    12054 ;7.6cm to 12.5cm
    12055 ;12.6cm to 20.0cm
    12056 ;20.1cm to 30.0cm
    12057 ;over 30.0 cm

    13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
    13152 ; 2.6 cm to 7.5 cm
    13153 ; each additional 5 cm

    92012 Established Intermediate Eye visit code

    92014 Established Comprehensive Eye visit code

    99211 – 99215 Established patient office E/M codes

    99218 – 99220 Observation care E/M codes

    99221 – 99223 New Inpatient E/M codes

    99231 – 99233 Established Inpatient E/M codes

    99291 – 99292 Critical care E/M codes

    99304 – 99306 Initial Nursing Facility care E/M codes

    99307 – 99310 Subsequent Nursing Facility care E/M codes

    99446 – 99449 Telephone/Internet/ EHR assessment

    99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time

    99452 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a treating/requesting physician or other qualified health care professional, 30 minutes
    All edits have an indicator of 1,
    With the exception of CPT codes
    99446 – 99451
    11104 Punch biopsy of skin (including simple closure, when performed); single lesion
    • Additional Edits
    11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion Indicator 0
    11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion
    • Additional Edits
    11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion

    11104 Punch biopsy of skin (including simple closure, when performed); single lesion
    Indicator 0
    +11103 each separate/ additional lesion (list separately in addition to code for primary procedure)

    +11105 each separate/ additional lesion (list separately in addition to code for primary procedure)

    +11107 each separate/ additional lesion (list separately in addition to code for primary procedure)
    12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5cm or less
    12013 ;2.6cm to 5.0cm
    12014 ;5.1cm to 7.5cm
    12015 ;7.6cm to 12.5cm
    12016 ;12.6cm to 20.0cm
    12017 ;20.1cm to 30.0cm
    12018 ;over 30.1cm

    12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less
    12052 ;2.6cm to 5.0cm
    12053 ;5.1cm to 7.5cm
    12054 ;7.6cm to 12.5cm
    12055 ;12.6cm to 20.0cm
    12056 ;20.1cm to 30.0cm
    12057 ;over 30.0 cm

    13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
    13152 ;2.6 cm to 7.5 cm
    13153 ;each additional 5 cm

    92012 Established Intermediate Eye visit code

    92014 Established Comprehensive Eye visit code

    99211 – 99215 Established patient office E/M codes

    99218 – 99220 Observation care E/M codes

    99221 – 99223 New Inpatient E/M codes

    99231 – 99233 Established Inpatient E/M codes

    99291 – 99292 Critical care E/M codes

    99304 – 99306 Initial Nursing Facility care E/M codes

    99307 – 99310 Subsequent Nursing Facility care E/M codes

    99446 – 99451
    Telephone/Internet/ EHR assessment
    All edits have an indicator of 1,
    With the exception of CPT codes
    99446 – 99451
    99273 Electroretinography (ERG), with interpretation and report; full field (ie, ffERG, flash ERG, Ganzfeld ERG) 99211 Established E/M code

    99446-99449 Telephone/Internet/ EHR assessment
    All edits have an indicator of 1
    99274 Electroretinography (ERG) with interpretation and report; multifocal (mfERG) 99211 Established E/M code

    99446-99449 Telephone/Internet/ EHR assessment
    All edits have an indicator of 1
    0509T Electroretinography (ERG) with interpretation and report, pattern (PERG) 99211 Established E/M code

    99446 – 99449 Telephone/Internet/ EHR assessment
    All edits have an indicator of 1
    0514T Intraoperative visual axis identification using patient fixation (List separately in addition to code for primary procedure)

    12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5cm or less
    12013 ;2.6cm to 5.0cm
    12014 ;5.1cm to 7.5cm
    12015 ;7.6cm to 12.5cm
    12016 ;12.6cm to 20.0cm
    12017 ;20.1cm to 30.0cm
    12018 ;over 30.1cm

    12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less
    12052 ;2.6cm to 5.0cm
    12053 ;5.1cm to 7.5cm
    12054 ;7.6cm to 12.5cm
    12055 ;12.6cm to 20.0cm
    12056 ;20.1cm to 30.0cm
    12057 ;over 30.0 cm

    13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
    13152 ;2.6 cm to 7.5 cm
    13153 ;each additional 5 cm

    92012 Established Intermediate Eye visit code

    92014 Established Comprehensive Eye visit code

    99211 – 99215 Established patient office E/M codes

    99218 – 99220 Observation care E/M codes

    99221 – 99223 New Inpatient E/M codes

    99231 – 99233 Established Inpatient E/M codes

    99291 – 99292 Critical care E/M codes

    99304 – 99306 Initial Nursing Facility care E/M codes

    99307 – 99310 Subsequent Nursing Facility care E/M codes

    99155 – 99157
    Moderate sedation E/M codes

    All edits have an indicator of 1,
    With the exception of CPT codes
    99155 – 99157
    67810 Incisional biopsy of eyelid skin including lid margin 11102 – 11106 Biopsy of skin

    99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time

    99452 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time

    All edits have an indicator of 1, with the exception of CPT codes
    99451 – 99452
    68100 Incisional biopsy of eyelid skin including lid margin 11102 – 11107 Biopsy of skin

    99451 – 99452 Telephone/Internet/ EHR assessment
    All edits have an indicator of 1, with the exception of CPT codes
    99451 – 99452
    11310 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion

    99451 – 99452 Telephone/Internet/ EHR assessment
    Indicator of 1, with the exception of CPT codes
    99451 – 99452
    11311 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm

    11440 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm

    17110 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions

    17280 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less

    11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion

    11104 Punch biopsy of skin (including simple closure, when performed); single lesion

    99451 – 99452 Telephone/Internet/ EHR assessment
    Indicator of 1, with the exception of CPT codes
    99451 – 99452
    11312 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm 11313 ;diameter over 2.0 cm

    11441 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; diameter 0.6 to 1.0 cm
    11442 ;diameter 1.1 to 2.0 cm
    11443 ;diameter 2.1 to over 3.0 cm
    11444 ;diameter 3.1 to over 4.0 cm
    11446 ;diameter over 4.0 cm

    11640 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less
    11641 ;excised diameter 0.6 to 1.0 cm
    11642 ;excised diameter 1.1 to 2.0 cm
    11643 ;excised diameter 2.1 to 3.0 cm
    11644 ;excised diameter 3.1 to 4.0 cm
    11646 ;excised diameter over 4.0 cm

    14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less
    14041 ;defect 10.1 sq cm to 30.0 sq cm

    14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less
    14061 ;defect 10.1 sq cm to 30.0 sq cm

    15120 Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)

    15260 Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less

    15576 Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips or intraoral

    15820 Blepharoplasty, lower eyelid
    15821 ;with extensive herniated fat pad

    15822 Blepharoplasty, upper eyelid
    15823 ;with excessive skin weighting down lid

    17281 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm
    17282 ;lesion diameter 1.1 to 2.0 cm
    17283 ;lesion diameter 2.1 to 3.0 cm
    17284 ;lesion diameter 3.1 to 4.0 cm
    17286 ;lesion diameter over 4.0 cm
    11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion

    11104 Punch biopsy of skin (including simple closure, when performed); single lesion

    11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion

    99451 – 99452 Telephone/Internet/ EHR assessment
    Indicator of 1, with the exception of CPT codes
    99451 – 99452