• Latest CCI Edits Bundle Oculofacial Codes 15730, 15733


    The Correct Coding Initiative edits, V24.0 effective Jan. 1, 2018, have limited effect on ophthalmology, compared to previous quarters. The only edits affect two new oculofacial surgical codes:

    • CPT code 15730 Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s); and
    • CPT code 15733 Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)

    The new edits bundle the following CPT codes with these two surgical codes. Each has an indicator of 1, meaning you may sometimes unbundle the codes. See below for specifics.

    • 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less
    • 12013 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm
    • 12014 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm
    • 12015 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm
    • 12016 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm
    • 12017 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm
    • 12018 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm
    • 12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less
    • 12052 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm
    • 12053 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm
    • 12054 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm
    • 12055 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm
    • 12056 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm
    • 12057 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm
    • 13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
    • 13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm
    • 13153 Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List separately in addition to code for primary procedure)
    • 92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient
    • 92014 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, 1 or more visits
    • Established patient E/M codes: 99211, 99212, 99213, 99214 and 99215

     Coding tips:

    • The indicators “0” or “1” show whether or not you may ever break a bundle.
      • “0” is mutually exclusive, meaning you can never unbundle these two codes. The most common example is 92134 Retina OCT is mutually exclusive with 92133 Optic nerve OCT.
      • “1” indicates you can break the bundle if you meet guidelines. For example, you may unbundle CPT code 92225 Extended ophthalmoscopy with modifier -59 from CPT code 67228 PRP, if you perform the test in the opposite eye.
    • When submitting multiple services, remember to always check bundling edits for all the code combinations.

    To see all CCI edits, visit the Academy’s Coding Updates and Resources.

    You can also find current CCI edits in Coding Coach: Complete Ophthalmic Coding Reference and Retina Coding: Complete Reference Guide.