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2007 PMCC Eye, Ocular Adnexa, and Ear Chapter 17 Chapter

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Title: 2007 PMCC Eye, Ocular Adnexa, and Ear Chapter 17 Chapter


1
2007 PMCCEye, Ocular Adnexa, and Ear Chapter
17
2
Chapter Outline
  • Introduce students to
  • Code ranges for the eye
  • Code ranges for the ear
  • Anatomy of the eyes and ears
  • Terminology and procedures related to the eyes
    and ears

3
Diagnosis Coding
  • Diabetic Retinopathy
  • The effect of diabetes on the eye is called
    diabetic retinopathy
  • In the earliest phase of the disease, called
    background diabetic retinopathy
  • The arteries in the retina become weakened and
    leak, forming small, dot-like hemorrhages
  • These leaking vessels often lead to swelling or
    edema in the retina and decreased vision
  • In the next stage, known as proliferative
    diabetic retinopathy
  • Circulation problems cause areas of the retina to
    become oxygen-deprived or ischemic
  • New, fragile vessels develop as the circulatory
    system attempts to maintain adequate oxygen
    levels within the retina
  • These vessels hemorrhage easily and blood may
    leak into the retina and vitreous causing spots
    or floaters along with decreased vision

4
Evaluation and Management (E/M) Coding for
Ophthalmology
  • Ophthalmologists have a choice when
  • Selecting codes for patient evaluation and
    management services
  • Providers may use either
  • The general ophthalmological services codes in
    the Medicine section of CPT or
  • The appropriate E/M codes for office or other
    outpatient services
  • Codes 92002-92014
  • Describe general ophthalmological services
  • Have specific code descriptions

5
Surgical Coding for Ophthalmology
  • Good working knowledge of
  • Medical terminology, including prefixes and
    suffixes
  • Very useful in coding ophthalmologic procedures
  • The suffix -ostomy is defined as
  • Any operation in which a permanent opening is
    created between two hollow organs or between a
    hollow viscus and external skin
  • Prefix intra-
  • Inside or within
  • Goniotomysurgical opening of the trabecular
    meshwork
  • Surgical procedure used in congenital glaucoma
  • Code 65820 reports a goniotomy

6
Eyeball (65091-65290)
  • The subheadings in CPT under the Eyeball heading
    identify the following types of procedures
  • Removal of Eye
  • Secondary Implant(s) Procedures
  • Removal of Foreign Body
  • Repair of Laceration

7
Removal of Eye (65091-65114)
  • Eviscerationremoval of the contents of the
    eyeball with the exception of the sclera
  • Diagnosis for an evisceration may be
  • Tumor of the eyeball, severe eyeball injury (such
    as a ruptured eye), purulent endophthalmitis,
    acute endophthalmitis, etc
  • Code 65091evisceration of ocular contents
    without an implant
  • Code 65093evisceration of ocular contents with
    an implant inserted into the scleral shell
  • Orbit exenterationremoval of the entire contents
    of the orbit
  • Code 65110exenteration of the orbit without a
    skin graft
  • Code 65112exenteration of the orbit with
    therapeutic removal of pieces of orbital bone

8
Secondary Implant Procedures (65125-65175)
  • Code 65125modification of an ocular implant that
    has been created elsewhere
  • Modifications may include
  • The addition of screws or other prosthetic
    appendages to alter the shape of the prosthesis
    so that it better fits the patients eye socket
  • Holes may be drilled to accommodate the screws
  • CPT describes an ocular implant as
  • An implant inside the muscular cone and
  • While an orbital implant is described as an
    implant outside the muscular cone, an ocular
    implant is placed in the eye socket or orbit
  • An intraocular lens (IOL) is placed in the
    capsular bag
  • Be aware of whether the muscles were or were not
    attached to the implant

9
Secondary Implant Procedures (65125-65175)
  • Code 65130insertion of an ocular implant that is
    secondary, after evisceration, in the scleral
    shell
  • Not to be used for describing the insertion of an
    intraocular lens (IOL) after cataract removal
  • If the implant is placed secondary to enucleation
  • See codes 65103 or 65105
  • Code 65135insertion of an ocular implant
    secondary after enucleation with muscles not
    attached to the implant
  • Code 65140insertion of an ocular implant with
    muscles attached to the implant

10
Removal of Foreign Body (65205-65265)
  • Procedures described under this subheading
    account for
  • Conjunctival and corneal foreign body removal
  • A foreign body may be superficial and/or
    embedded
  • A slit lamp may be used to assist in the removal
    of a foreign body including corneal foreign
    bodies
  • Codes 65235-65265
  • Intraocular location of a foreign body in the
    anterior and posterior segments and lens
  • Code 67938
  • Removal of embedded foreign body from eyelid

11
Repair of Laceration (65270-65290)
  • Codes under this subheading are used to report
  • Various laceration repairs for ocular anatomical
    structures other than the iris or ciliary body
  • Code 65270repair of a conjunctival laceration by
    direct closure
  • With or without a nonperforating laceration of
    the sclera
  • Code 65273laceration repair of the conjunctiva
    by mobilization and rearrangement with
    hospitalization
  • Code 65280repair of a corneal and/or scleral
    laceration that does not involve uveal tissue
  • Code 65290wound repair for an extraocular
    muscle, tendon, and/or Tenons capsule

12
Anterior Segment (65400-66999)
  • The primary categories under the Anterior Segment
    heading identify the following anatomical
    structures
  • Cornea
  • Anterior Chamber
  • Anterior Sclera
  • Iris, Ciliary Body
  • Lens

13
Cornea (65400-65782)
  • Excision (65400-65426)
  • The excision of a lesion of the cornea is a
    surgical procedure known as a partial lamellar
  • Lamellarpartial thickness of the cornea
  • Code 65400 reports the service
  • Excision of pterygium is not included
  • Pterygiumwing-like structure that usually
    consists of a membrane that extends from the
    medial canthus to the cornea or beyond the cornea
    with an apex that points to the pupil and is
    attached to the sclera
  • Code 65420excision or transposition of a
    pterygium without a graft
  • Code 65426excision or transposition of a
    pterygium with a graft

14
Removal or Destruction of Corneal Defects
(65430-65600)
  • Codes found under this subheading include
  • A diagnostic scraping of the cornea to obtain a
    smear and/or culture
  • The tissue removed during scraping may be
    cultured to determine a diagnosis
  • Code 65430diagnostic scraping of the cornea for
    smear and/or culture
  • Code 65435 should be used to report
  • Removal of corneal epithelium with or without
    chemocauterization by abrasion or curettage
  • Code 65450
  • Destruction of a corneal lesion by cryotherapy,
    photocoagulation, or thermocauterization

15
Keratoplasty (65710-65755)
  • Keratoplastyplastic repair of the cornea
  • Includes the use of fresh or preserved grafts and
    preparation of donor material for cornea
    transplant
  • Normally performed using an operating microscope
  • Code 65730penetrating keratoplasty, except in
    aphakia
  • When the patient has a natural lens
  • A key consideration when determining a code for
    keratoplasties
  • Determining the lens status of the patient
  • Aphakiathe absence of the lens of the eye
  • Code 65755keratoplasty of pseudophakic patient
  • Patient who does not have a natural lens but and
    artificial intraocular lens (IOL)

16
Other Procedures (65760-65782)
  • Code 65760 keratomileusis
  • Is a procedure to alter visual acuity
  • In this procedure, a partial-thickness of the
    central portion of the cornea is removed, frozen,
    reshaped on an electronic lathe, positioned, and
    then sutured into place
  • Three codes (65780, 65781, 65782)
  • Types of ocular surface reconstruction using stem
    cells

17
Anterior Chamber (65800-66030)
  • Incision (65800-65860)
  • A paracentesis procedure (65800-65815) is done
    for
  • Removal of aqueous humor from the anterior
    chamber for diagnostic analysis or
  • To quickly and temporarily reduce eye pressure as
    a therapeutic procedure
  • A YAG laser is usually employed if there is
    discission of the anterior hyaloid membrane
  • A trabeculotomy is a procedure done for severing
    adhesions of the anterior segment
  • Code 65850 reports a trabeculotomy ab externo
  • Other Procedures (65865-66030)
  • A patient diagnosed with anterior synechiae or
    goniosynechiae
  • May require a procedure that entails the severing
    of adhesions
  • Code 65870incisional technique for severing
    anterior synechia, with or without the injection
    of air, except goniosynechiae

18
Anterior Sclera (66130-66250)
  • Excision (66130-66185)
  • Physicians remove scleral lesions by
  • Cutting through the thin, transparent
    conjunctiva, and snipping the lesion with scleral
    scissors
  • Common diagnoses documented may include, but are
    not limited to
  • Malignant neoplasm of the eyeball and carcinoma
    in situ of the eyeball
  • Code 66130scleral lesion excision
  • Code 66172trabeculectomy with scarring from
    previous ocular surgery or trauma
  • Also includes injection of antifibrotic agents
  • Repair or Revision (66220-66250)
  • Staphylomabulging protrusion of the eyeballs
    vascular coating
  • Code 66220repair of a scleral staphyloma without
    graft
  • Code 66225repair of a scleral staphyloma with a
    scleral tissue graft

19
Iris, Ciliary Body (66500-66770)
  • Incision (66500-66505)
  • Iridotomyincision into the iris
  • Patients diagnosed with adhesions or disruptions
    of the pupillary membranes (eg, iris bombe)
    occlusion or seclusion of the pupillary membrane
    may require an iridotomy procedure (incision into
    the iris)
  • With an iris bombe condition
  • The iris bulges forward into the anterior chamber
    due to pressure built up from an accumulation of
    aqueous fluid between the iris and the lens in
    the posterior chamber
  • A stab incision is used to slice through the iris
    in a side-to-side technique
  • Which increases the flow of the fluids that was
    initially slowed due to a pupillary block
  • Code 66505iridotomy by stab incision with
    transfixion as for iris bombe

20
Iris, Ciliary Body (66500-66770)
  • Excision (66600-66635)
  • Iridectomyremoval of part of the iris
  • To remove a lesion from the iris
  • A surgeon may choose to perform an iridectomy
    (removal of part of the iris) with a
    corneoscleral section or corneal section
  • Using deep laser burns, an incision is made
    through a conjunctival flap
  • An Argon laser is used to excise the affected
    iris along with other involved structures.
  • Use code 66600 for this procedure
  • Code 66630iridectomy performed for sector
    glaucoma
  • This procedure is usually a component of a more
    complex service
  • When performed with other unrelated procedures
  • Code 66630 may be reported with the modifier 59

21
Iris, Ciliary Body (66500-66770)
  • Repair (66680-66682)
  • A patient with degeneration of the iris and/or
    ciliary body
  • May require a surgical procedure to repair and/or
    suture the iris and/or ciliary body
  • Code 66680repair of the iris or ciliary body
  • Code 66682when tear of the iris or ciliary body
    requires suture with removal of suture through
    small incision affixed to the ciliary body
  • Destruction (66700-66770)
  • When high intraocular pressure cannot be
    otherwise controlled
  • Portions of the ciliary body are destroyed to
    reduce the production of aqueous humor
  • Codes 66700-66740 report
  • The use of a heat probe, laser, or freezing probe

22
Lens (66820-66999)
  • Incision (66820-66825)
  • When an extracapsular extraction is performed
  • The posterior part of the lens capsule is left
    intact
  • At times, this structure may become opaque or
    membranes may grow secondary to the original
    procedure
  • Opaque membranes are removed by cutting with a
    needle knife
  • When coding incision of secondary cataract
  • It is important to differentiate between the
    techniques of stab incision or laser surgery
  • Code 66820discission of a secondary membranous
    cataract by stab incision technique with a
    Ziegler or Wheeler knife  
  • Code 66821treatment of a secondary membranous
    cataract by laser technique
  • Requires diagnosis after cataract, obscuring
    vision (366.5 range)

23
Removal of Cataract (66830-66990)
  • The presence of a cataract is a pathological
    condition caused by
  • Trauma, disease, or age that results in
    cloudiness of the lens
  • This cloudiness does not permit light to focus
    properly through the lens, creating diminished
    vision for the patient
  • If the vision loss is significant,
  • Surgical removal of the lens, with replacement of
    an IOL to restore focusing power, is an option
  • Code 66830removal of a secondary membranous
    cataract using a corneoscleral section with or
    without iridectomy
  • Code 66840removal of lens material using an
    aspiration technique to destroy and suck the lens
    away
  • It is only used on the softest of cataracts, such
    as infantile cataracts

24
Removal of Cataract (66830-66990)
  • Cataract extraction is usually performed using
    local anesthesia and IV sedation
  • The different techniques include
  • Intracapsular cataract extraction (ICCE)
  • Now rarely performed (see codes 66920, 66930, and
    66983)
  • Extracapsular cataract extraction (ECCE)
  • See code 66940, which consists of removing the
    hard central nucleus in one piece then removing
    the soft cortex in multiple small pieces
  • Codes 66940 and 66984
  • Pertain specifically to the extracapsular removal
    of lens material
  • Code 66984 includes the insertion of an IOL
    prosthesis

25
Posterior Segment (67005-67299)
  • The subheadings under the Posterior Segment
    identify procedures for the following anatomical
    structures
  • Vitreous
  • Retina or Choroid
  • Sclera

26
Vitreous (67005-67040)
  • Vitreous hemorrhageextravasation of blood into
    the vitreous
  • May occur in conditions such as
  • Retinal vein occlusion
  • Diabetic retinopathy
  • Posterior vitreous detachment
  • Retinal neovascularization
  • Retinal tears
  • Ocular trauma

27
Vitreous (67005-67040)
  • Code 67005 describes an
  • Open sky technique
  • Refers to an incision made at the corneal edge or
    limbus
  • A needle is passed to the back of the anterior
    segment where displaced vitreous humor is removed
    by aspiration
  • Some of the codes in the Vitreous subcategory
    (codes 67015, 67025, 67036-67040)
  • Refer to a pars plana approach
  • Refers to the flattened posterior portion of the
    ciliary body located 4 mm behind the
    corneoscleral junction
  • Code 67025injection of a vitreous substitute
  • Refers to injection of Healon or silicone
  • Not air or balanced salt solutions

28
Retina or Choroid (67101-67228)
  • Retinal detachmentseparation of the retina from
    the underlying retinal pigment epithelium
  • Early symptoms may include vitreous floaters,
    flashes of light, or blurred vision
  • Direct ophthalmoscopy can indicate retinal
    irregularities and a bullous retinal elevation
    with darkened blood vessels
  • Repair (67101-67121)
  • Codes 67101-67112 require a diagnosis of retinal
    detachment
  • The operative report must be reviewed carefully
  • To determine the appropriate code to report from
    this group of codes
  • If several methods are combined, such as
    diathermy, cryotherapy and/or photocoagulation,
    report the code that describes the principal
    modality

29
Prophylaxis (67141-67145)
  • Retinal breaks and lattice degeneration
    detachments
  • May require a procedure to secure the retina by
    cryotherapy (freezing) or by diathermy (heat)
  • Prophylactic treatments for retinal detachment
    are coded according to the method used
  • CPT notes that the procedure may require one or
    more sessions
  • Modifier 58 (staged procedure) should not be
    attached to these codes
  • The definitions of these codes denote repetitive
    services and staging is inclusive

30
Destruction (67208-67228)
  • A patient diagnosed with localized lesions of the
    choroid, caused by age-related macular
    degeneration
  • May undergo a procedure requiring ocular
    photodynamic therapy (OPT) utilizing a
    photosensitive drug or a laser treatment that
    treats choroidal neovascularization
  • Code 67220 reports the laser procedure
  • Describes destruction of a localized lesion of
    choroid, one or more sessions, by
    photocoagulation using laser
  • Code 67227
  • Destruction of extensive or progressive
    retinopathy using cryotherapy or diathermy

31
Sclera (67250-67255)
  • Repair (67250-67255)
  • When a patient is diagnosed with a tear in the
    ocular tissue without displacement of the
    structures or other types of superficial injuries
    to the eye, or contusion to the eyeball
  • The surgeon may perform a scleral reinforcement
    procedure to repair the weakened sclera
  • Codes 67250-67255 are used to report scleral
    reinforcement procedures

32
Ocular Adnexa (67311-67999)
  • Extraocular Muscles (67311-67399)
  • The muscles controlling vertical eye movement are
    the
  • Superior rectus and Inferior rectus
  • Superior oblique and Inferior oblique
  • Muscles controlling horizontal movement include
    the
  • Medial rectus and the lateral rectus
  • A resection procedure involves
  • Detaching the extraocular muscle from the eye
  • Removing part of the muscle tissue and
  • Resuturing it to the eye, usually at the original
    site
  • Codes 67311-67318 are the primary strabismus
    codes that identify
  • Resection or recession procedures used to
    strengthen or weaken each eye muscle or a
    combination of eye muscles

33
Ocular Adnexa (67311-67999)
  • New codes
  • 67346 Biopsy of extraocular muscle
  • Code 67350 has been deleted and renumbered to
    code 67346 with no change in the code terminology
    to correct the assumption that this code was not
    related to the extraocular muscle procedures
    (67311-67345) due to its former placement under
    the Other Procedures subheading
  • New code 67346 is now correctly located under the
    Extraocular Muscles subheading in the Eye and
    Ocular Adnexa subsection
  • A cross-reference has been added to direct users
    to the new code
  • Deleted codes
  • 67350 Biopsy of extraocular muscle

34
Orbit (67400-67599)
  • Exploration, Excision, Decompression
    (67400-67450)
  • Orbitotomies without bone flaps, and using a
    frontal or transconjunctival approach for
    exploration/drainage, to remove lesions, foreign
    bodies or bone removal for decompression
  • Reported using codes 67400-67414
  • Orbitotomies with bone flaps or windows
  • Reported using codes 67420-67450
  • Other Procedures (67500-67599)
  • Injection procedures include codes 67500-67515
  • Retrobulbar injections are used to introduce
    medication or alcohol to the muscle cone behind
    the eye
  • Therapeutic agents are introduced by injection
    along the surface of the globe beneath the
    conjunctiva and between the sclera and Tenons
    capsule

35
Eyelids (67700-67999)
  • Incision (67700-67715)
  • Code 67700blepharotomy
  • Performed to drain an eyelid abscess when a
    patient is diagnosed with a hordeolum or other
    deep inflammation, abscess, or cysts
  • Code 67715canthotomy
  • Performed when a patient is diagnosed with an
    orbital hemorrhage or blepharophimosis
  • Excision (67800-67850)
  • Trichiasisingrown eyelashes
  • Correction of trichiasis by forceps
    epilationcode 67820
  • Correct of trichiasis with electrosurgery,
    cryotherapy, or laser surgerycode 67825

36
Eyelids (67700-67999)
  • Tarsorrhaphy (67875-67882)
  • Tarsorrhaphyeyelid is sutured to unite the edges
    of the lids and close the palpebral fissure,
    which is the linear opening between the eyelids
  • Code 67875 should be reported
  • When the provider uses Frost sutures for
    temporary closure of the eyelids
  • Repair (Brow Ptosis, Blepharoptosis, Lid
    Retraction, Ectropion, Entropion) (67900-67924)
  • To repair ectropionsee codes 67914-67917
  • To repair entropionsee codes 67921-97924

37
Eyelids (67700-67999)
  • Reconstruction (67930-67975)
  • Codes 67930-67935suture of recent
    partial-thickness and full-thickness eyelid
    wounds
  • These wounds are irrigated and sutured in layers
  • Code 67938removal of an embedded foreign body in
    the anterior or posterior surface of the eyelid
  • The embedded foreign body is excised and the
    wound is sutured
  • Codes 67961-67966
  • Reports full-thickness excision and repair of
    eyelid
  • Piece of eyelid is excised and surrounding tissue
    is rearranged to compensate for the defect

38
Conjunctiva (68020-68899)
  • Incision and Drainage (68020-68040)
  • Conjunctival cystabnormal, thin-walled sac of
    fluid in the conjunctiva
  • When a conjunctival cyst or a sebaceous cyst
    undergoes a procedure in which a vertical or
    horizontal incision is made in the posterior
    surface of the eyelid to drain fluid or matter
  • Code 68020 reports drainage of a conjunctival or
    sebaceous cyst
  • Excision and/or Destruction (68100-68135)
  • Code 68110excision of a lesion of the
    conjunctiva that is up to 1 cm
  • Code 68115excision of a lesion over 1 cm
  • Conjunctivoplasty (68320-68899)
  • Symblepharonan adhesion between the conjunctiva
    on the eyeball and the conjunctiva on the inner
    eyelid
  • In a symblepharon repair procedure, the adhesions
    are divided and a graft is used, if needed
  • Codes 68330-68340 report various types of this
    procedure

39
Lacrimal System (68400-68899)
  • Incision (68400-68440)
  • The lacrimal system serves to keep the
    conjunctiva and cornea moist through the
  • Production, distribution, and elimination of
    tears
  • Lacrimal punctasmall openings in the inner
    canthus of the eyelids that channel tears
    produced by the lacrimal gland
  • A snip incision of the lacrimal punctum is
    commonly performed
  • When a patient has a diagnosis of stenosis of the
    lacrimal punctum, epiphora (overproduction of
    tears), or a tear film insufficiency
  • Code 68440 reports a snip incision of lacrimal
    punctum
  • Excision (68500-68550)
  • For total or partial lacrimal gland removal
  • See codes 68500-68505
  • Code 68510biopsy of the lacrimal gland
  • Code 68520excision of the lacrimal sac

40
Lacrimal System (68400-68899)
  • Repair (68700-68770)
  • Conjunctivorhinostomy procedure (68745-68750)
  • Sac is connected to the nasal mucosa by a series
    of interrupted sutures
  • Glass tube or stent may be inserted to create a
    connection between the lacrimal system and the
    nasal mucosa (68750)
  • Probing and/or Related Procedures (68801-68850)
  • Code 68801dilation of the lacrimal punctum, with
    or without irrigation
  • Injection of contrast material for
    dacryocystography
  • Use code 68850 and
  • Supervision and interpretation of radiographic
    results reported separately with code 70170

41
Ocular Ultrasound Procedures
  • Several ultrasound procedures detailed in the
    Radiology section that ophthalmologists use for
    diagnostic determination of conditions
  • The most frequently used codes to describe
    ophthalmic ultrasound are
  • Codes 76510, 76511, 76512, and 76519
  • Code 76519ophthalmic biometry by ultrasound
    echography, A-scan with intraocular lens power
    calculation
  • Describes the procedure used to determine the
    axial length or a size measurement of the eyeball
  • Code 76514corneal pachymetry
  • Used to determine corneal thickness
  • Code 76519ophthalmic biometry by ultrasound
    echography, using intraocular lens power
    calculation, A-scan

42
Auditory System (69000-69979)
  • Introduction
  • The ear consists of three major parts
  • The external ear, the middle ear, the inner ear
  • Outer ear includes
  • The pinna (visible part) and the ear canal
  • Cochlea
  • Contains the hearing organ that converts sound
    into electrical signals that are associated with
    the origin of impulses carried by nerves to the
    brain

43
Diagnostic Coding
  • Diseases of the Ear and Mastoid Process (380-389)
  • Chapter 6, Diseases of the Nervous System and
    Sense Organs (320-389) includes
  • The subsection that describes diseases of the ear
    and mastoid process
  • Otitis mediainfection or inflammation of the
    middle ear
  • Often begins when infections that cause
  • Sore throats, colds, or other respiratory or
    breathing problems spread to the middle ear
  • Hearing Loss
  • Hearing loss, tinnitus, vertigo, earache, and
    otorrhea are
  • The principal symptoms of ear problems
  • When a patient has complaints referable to the
    ears
  • A thorough history should be taken and a physical
    examination performed with emphasis on the
  • Ears, nose, nasopharynx, and paranasal sinuses

44
Diagnostic Coding
  • Auditory Processing Disorder
  • Refers to the abnormal interaction of
  • Hearing, neural transmission, and the brains
    ability to make sense of sound
  • People with auditory processing disorders may
    have normal hearing
  • But they have difficulty understanding auditory
    information
  • This may be apparent by difficulty understanding
    speech in the presence in
  • Noise, problems following multi-step directions,
    and difficulty with phonics or reading
    comprehension

45
External Ear (69000-69399)
  • The external ear consists of the
  • Auricle and the auditory canal
  • Different parts of the auricle include
  • The helix (the top of the ear)
  • The tragus (a wedge of skin-covered cartilage at
    the front of the ear
  • The lobe (the soft tissue at the bottom of the
    ear)
  • The external auditory meatus refers to the
  • Opening of the ear canal

46
External Ear (69000-69399)
  • Incision (69000-69090)
  • Perichondritisan infection of the perichondrium
    of the pinna
  • The blood supply to the cartilage is provided by
    the perichondrium
  • If the perichondrium is separated from both sides
    of the cartilage, the resulting avascular
    necrosis leads to a deformed pinna
  • A provider may perform
  • An incision and drainage by means of suction to
    the external ear to approximate the blood supply
    to the cartilage
  • Code 69000 reports simple drainage of the
    external ear for abscess or hematoma

47
External Ear (69000-69399)
  • Excision (69100-69155)
  • Code 69100biopsy of the external ear
  • Code 69105biopsy of the external auditory canal
  • If the entire lesion is removed from the external
    ear
  • Report code 69110
  • Some of the ear excision procedures
  • May require skin grafting and/or reconstruction
    of the ear
  • Excision exostosis (es), external auditory canal
  • Refers to the removal of an exostosis, a benign
    bony growth, from the ear canal
  • To remove an exostosis
  • The surgeon makes an incision through the skin
    above the exostosis to expose the bone beneath it
  • The bony growth is chipped away with a chisel or
    drill
  • Code 69140excision of an exostosis or exostoses
    of the external auditory canal

48
External Ear (69000-69399)
  • Removal (69200-69222)
  • Reconstruction of the inner ear
  • May involve removing the ossicles and burying
    these bones inside the ear for later use
  • Code 69200removal foreign body from external
    auditory canal without general anesthesia
  • Code 69205removal foreign body from external
    auditory canal with general anesthesia
  • Repair (69300-69320)
  • OtoplastySurgical procedure (cosmetic) performed
    to correct protruding ear(s)
  • When a surgeon performs an otoplasty
  • An incision is made on the posterior auricle
  • A new antihelical fold is created
  • The cartilage and ear size may also be reduced
  • Code 69300 reports an otoplasty

49
Middle Ear (69400-69799)
  • Structures that make up the middle ear include
    the
  • Tympanic membrane (eardrum)
  • The auditory ossicles, and four openings
  • The auditory ossicles consist of three small
    bones commonly known as the
  • Hammer, anvil, and stirrup
  • These middle ear bones are linked
  • To allow the transmission of sound waves
  • The eustachian tubes
  • Open on the front wall of the middle ear and
    extends to the pharynx
  • Are 3 to 4 cm. long and are lined with a mucous
    membrane
  • Permit equalization of air pressure between the
    internal ear and the outside of the body

50
Middle Ear (69400-69799)
  • Introduction (69400-69405)
  • When a surgeon performs eustachian tube inflation
  • A catheter is inserted via nasal cavity with the
    aid of a nasopharyngoscope
  • The tube is inflated and the catheter is removed
  • This procedure is performed when a patient has
  • Chronic serous otitis media
  • Code 69400eustachian tube inflation with
    catheterization
  • Code 69401eustachian tube inflation without
    catheterization
  • Incision (69420-69450)
  • Myringotomysurgical incision of the tympanic
    membrane
  • In this procedure
  • Fluid is gently suctioned out of the middle ear
  • Code 69420myringotomy done under a local
    anesthesia
  • Code 69421used when a general anesthesia is
    required for a myringotomy

51
Middle Ear (69400-69799)
  • Tympanostomy (69433-69436)
  • The surgical insertion of ventilation tubes into
    the eardrum, where they remain to allow for
    continual drainage of fluid and normalization of
    pressure in the ear space
  • Code 69436tympanostomy requiring insertion of a
    ventilating tube
  • To report a bilateral tympanostomy with
    ventilation tube insertion, use modifier 50
  • Excision (69501-69554)
  • Mastoidectomy (69501-69511)
  • Surgical procedure designed to remove infection
    or growths in the mastoid bone
  • Code 69511radical mastoidectomy
  • Removes most of the bone and is indicated for
    extensive spread of a cholesteatoma
  • Eardrum and middle ear structures may be
    completely removed
  • For skin graft, see 15004

52
Middle Ear (69400-69799)
  • Repair (69601-69676)
  • Codes 69631-69646 refer to a tympanoplasty
  • A tympanoplasty is a surgical procedure that
    involves repairing or reconstructing the eardrum
  • Code 69631tympanoplasty without mastoidectomy
  • Procedure in which the middle ear is explored
  • If adhesions or squamous debris are located
  • The surgeon removes them and palpates the ossicles

53
Inner Ear (69801-69949)
  • The inner ear
  • Consists of a bony labyrinth within the temporal
    bone lying on either side of the head
  • This complex structure has three parts
  • The semicircular canals, the vestibule, and the
    cochlea
  • The three semicircular canals
  • Maintain equilibrium
  • Merge into the vestibule, which contains fluid
  • The oval window, in the middle ear
  • Covers the vestibule, which contains perilymph
    fluid

54
Inner Ear (69801-69949)
  • Incision and/or Destruction (69801-69840)
  • Ménières disease
  • Characterized by recurrent prostrating vertigo,
    sensory hearing loss, tinnitus, and a feeling of
    fullness in the ear associated with generalized
    dilation of the membranous labyrinth
    (endolymphatic hydrops)
  • A patient diagnosed with active Ménières disease
    may undergo a procedure called a labyrinthotomy
  • Under microscopic guidance
  • Placement of a small permanent or temporary tack
    is inserted through the stapes footplate, or a
    hook is placed through the round window during
    the labyrinthotomy by transcanal approach
  • Code 69801 reported when the canal is packed
    (transcanal approach)
  • Code 69802 used when the mastoid cavity is
    packed and the incision is closed (mastoidectomy
    approach)

55
Inner Ear (69801-69949)
  • Excision (69905-69915)
  • Labyrinthectomy (69905-69910)
  • Inner labyrinth is exposed and the semicircular
    canals are drilled away, exposing the nerve of
    balance that is removed
  • May be performed for individuals with complete or
    near complete hearing loss in one ear due to
    Ménières
  • A vestibular nerve section is performed when
  • A patient is diagnosed with acute mastoiditis
    accompanied with other complications or
    vestibular neuronitis (a benign disorder
    characterized by sudden onset of severe vertigo
    that can last seven to 10 days)
  • Code 69915 reports a vestibular nerve section by
    translabyrinth approach

56
Temporal Bone, Middle Fossa Approach (69950-69979)
  • The temporal bones form a part of the base of the
    skull
  • Among the hardest of all bones
  • Enclose the organs of the hearing and balance
    systems
  • The middle fossa approach provides surgical
    access to
  • Lesions of the geniculate ganglion and the
    labyrinthine portion of the facial nerve
  • The internal acoustic canal
  • Help preserve cochlear function

57
Temporal Bone, Middle Fossa Approach (69950-69979)
  • A patient diagnosed with Bells palsy shows
    symptoms of
  • Weakness to an entire half of the face
  • The extent of nerve damage determines patient
    outcome
  • A total nerve decompression and repair are common
    surgical procedures to repair the facial nerve
    damage
  • Several approaches are used via
  • Temporal bone, mastoid approach, or through the
    external auditory canal
  • If the nerve has been transected because of
    trauma
  • It can be repaired with sutures
  • Code 69955total facial nerve decompression
    and/or repair
  • Includes a graft when a graft is included as part
    of the surgical procedure

58
Operating Microscope (69990)
  • Code 69990 is used in addition to the primary
    procedure code
  • Key points to remember
  • Do not add modifier 51 to this CPT code
  • Code 69990 should not be used to report
    visualization with magnifying loupes or corrected
    vision
  • Do not report code 69990 with a primary procedure
    that uses an operating microscope as an integral
    component

59
The End
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