• Latest CCI Edits Bundle Numerous Ophthalmology Codes


    The latest quarterly National Correct Coding Initiative edits released by the Centers for Medicare and Medicaid Services bundle numerous ophthalmology codes. Edits take effect July 1, 2016. The ophthalmology CPT codes in column 2 are bundled with the CPT codes in column 1.

    The majority of codes have an indicator of 1, which means you can unbundle the codes when services provided meet the definition of modifier -59 or the –X modifiers. Typically this means the physician performed the procedures in separate eyes. However, several codes include the indicator of 0; this means these codes can never be unbundled.

    Column 1 Column 2 Indicator
    65757 Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure) 69990 Microsurgical techniques, requiring use of operating microscope 0
    65760 Keratomileusis 69990 Microsurgical techniques, requiring use of operating microscope 0
    65765 Keratophakia 69990 Microsurgical techniques, requiring use of operating microscope 0
    65767 Epikeratoplasty; also known as KEF 69990 Microsurgical techniques, requiring use of operating microscope 0
    65771 Radial keratotomy J0670 Injection, mepivacaine HCL, per 10 ml J2001 Injection, lidocaine HCL, up to 300 mg 1
    65785 Implantation of intrastromal corneal ring segments J0670 Injection, mepivacaine HCL, per 10 ml J2001 Injection, lidocaine HCL, up to 300 mg 1
    76510 Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device). Imaging supervision and interpretation 1
    76511 Ophthalmic ultrasound, diagnostic; quantitative A-scan only 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device). Imaging supervision and interpretation 1
    76512 Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed nonquantitative A-scan) 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device). Imaging supervision and interpretation 1
    76513 Ophthalmic ultrasound, diagnostic; anterior segment ultrasound, immersion (water bath) B-scan or high resolution biomicroscopy 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device). Imaging supervision and interpretation 1
    76514 Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness) 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device). Imaging supervision and interpretation 1
    76529 Ophthalmic ultrasonic foreign body localization 76942 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device). Imaging supervision and interpretation 1
    92025 Computerized corneal topography, unilateral or bilateral, with interpretation and report 65760 Keratomileusis 65765 Keratophakia 65767 Epikeratoplasty; also known as KEF 65771 Radial keratotomy   1
    99201-99205 New patient E/M exam codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99211-99215 Established patient E/M exam codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99217 observation care discharge 99173 Screening test of visual acuity, quantitative, bilateral 1
    99218-99220 Initial observation care E/M exam codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99224-99226 Subsequent observation care E/M exam codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99221-99223 Initial hospital care E/M exam codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99231-99233 Subsequent hospital care E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99234-99236 Observation or inpatient same day discharge E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99238-99239 Hospital discharge day management 99173 Screening test of visual acuity, quantitative, bilateral 1
    99241-99245 Office consultation E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99251-99255 Inpatient consultation E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99281-99285 Emergency department visit E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99291-99292 Critical care E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99304-99306 Initial nursing facility care E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99307-99310 Subsequent nursing facility E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99315-99316 Nursing facility discharge E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99324-99328 New patient domiciliary, rest home E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99334-99337 Established patient domiciliary, rest home E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99341-99345 New patient home visit E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1
    99347-99350 Established patient home visit E/M codes 99173 Screening test of visual acuity, quantitative, bilateral 1