• Minor Ophthalmology Bundling Changes for CCI Edits Effective April 1, 2018


    The current Correct Coding Initiative edits, effective April 1, 2018, have minor consequence for ophthalmology. In the table below, the Centers for Medicare and Medicaid Services now bundles the CPT codes in column 2 with the CPT codes in column 1.

    All three codes affected by the edit list the indicator 1, which means you can unbundle the codes when the case meets the definition of modifier -59 or -X modifiers. Typically, this means the provider performed the procedures in separate eyes.

    To see all CCI edits, visit Coding Updates and Resources.

    Column 1 Column 2 Indicator
    67961 Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin 14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm 1
    67966 Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin 14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm 1
    67971 Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; up to two-thirds of eyelid, 1 stage or first stage 14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm 1