• NCCI Edits Add Micro-Stent Category III Code, 0474T Bundling


    Updated Sept. 29, 2017
    The latest National Correct Coding Initiative edits, V23.3, affect ophthalmology in two main ways. The latest round of quarterly bundling edits takes effect Oct. 1. Key changes for ophthalmology include:

    • Addition of Category III code for the CyPass micro-stent: 0474T Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space. Learn more about the latest Category III codes.
    • Bundling 0474T with all other glaucoma procedures 65800 through 66185, the establish patient intermediate and comprehensive Eye visit codes and exams performed under anesthesia. 

    See all NCCI edits on the CMS website. You can also find current edits in the Coding Coach Complete Ophthalmic Reference online version.

    Column 1 Column 2 Indicator
    0469T Retinal polarization scan, ocular screening with on-site automated results, bilateral 92015 Refraction 0
    0474T  Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less 1
    0474T 12013 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm 1
    0474T 12014  Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm 1
    0474T 12015 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm 1
    0474T 12016 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm 1
    0474T 12017 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm 1
    0474T 12018 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm 1
    0474T 12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less 1
    0474T 12052 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm 1
    0474T 12053 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm 1
    0474T 12054 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm 1
    0474T 12055 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm 1
    0474T 12056 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm 1
    0474T 12057 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm 1
    0474T 13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm 1
    0474T 13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm 1
    0474T 13153 Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List separately in addition to code for primary procedure) 1
    0474T 65800 Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous 1
    0474T 65810 Paracentesis of anterior chamber of eye (separate procedure); with removal of vitreous and/or discission of anterior hyaloid membrane, with or without air injection 1
    0474T 65815 Paracentesis of anterior chamber of eye (separate procedure); with removal of blood, with or without irrigation and/or air injection 1
    0474T 66020 Injection, anterior chamber of eye (separate procedure); air or liquid 1
    0474T 66030 Injection, anterior chamber of eye (separate procedure); medication 1
    0474T 66170 Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery 1
    0474T 66172 Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents) 1
    0474T 66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft 1
    0474T 66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft 1
    0474T 67500 Retrobulbar injection; medication (separate procedure, does not include supply of medication) 1
    0474T 67515 Injection of medication or other substance into Tenon's capsule 1
    0474T 92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient 1
    0474T 92014 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits 1
    0474T 92018 Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; complete; also known as EUA 1
    0474T 92019 Ophthalmological examination and evaluation, under general anesthesia, with or without manipulation of globe for passive range of motion or other manipulation to facilitate diagnostic examination; limited 1
    0474T Established patient: 99211-99215 Inpatient exams: 99221-99223, 99231-99233 Consultation exams: 99241-99245, 99251-99255   1
    66170 Fistulization of scleral for glaucoma; trabeculectomy ab externo in absence of previous surgery 0474T  Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space 1
    66172 Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents) 0474T  Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space 1
    66179 Aqueous shunt to extraocular equatorial plate reservoir; external approach; without graft 0474T  Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space 1
    66180 Aqueous shunt to extraocular equatorial plate reservoir; external approach; with graft. 0474T  Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space 1
    66183 Insertion of anterior segment aqueous drainage device, without extraocular reservoir; external approach; also known as Express Shunt 0474T  Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space 1
    66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft 0474T  Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space 1
    66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft 0474T  Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space 1
    92002 Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient 0469T  Retinal polarization scan, ocular screening with on-site automated results, bilateral                1
    92012 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient 0469T  Retinal polarization scan, ocular screening with on-site automated results, bilateral 1
    92004 Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, one or more visits 0469T  Retinal polarization scan, ocular screening with on-site automated results, bilateral 1
    92014 Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; comprehensive, established patient, one or more visits 0469T  Retinal polarization scan, ocular screening with on-site automated results, bilateral 1
    New patient E/M: 99201-99205 Established patient E/M: 99211-99215 Inpatient exams: 99221-99223, 99231-99233 Consultation exams: 99241-99245, 99251-99255 0469T  Retinal polarization scan, ocular screening with on-site automated results, bilateral 1