E117

PDF page 768 / Y2

OCULAR SURGICAL PROCEDURES
CORNEA
                                                                                                     Asst         Surg         Anae
    INCISION
# Z851 Therapeutic paracentesis .......................................................      70.00 6
# E175     - therapeutic paracentesis done in conjunction with E186,
             E187 or E149 ............................................................. add  20.00
# Z844 Diagnostic Paracentesis for: 1) suspected intraocular infection;
           2) intraocular inflammation / uveitis; or 3) suspected cancer
           involving the intraocular structures or fluids .......................           100.00 6
      Payment rules:
      1.Z851 is not eligible for payment for same patient same day as E175 or Z844.
      2.Z851 and Z844 are not eligible for payment for same patient same day as E186, E187, or
        E149.
      3.Z844 is only eligible for payment if the sample obtained through paracentesis is sent for one
        or more of the following:
         a.culture
         b.cellular analysis
         c.molecular analysis
       CORNEAL CROSS-LINKING
         Corneal Cross Linking (CXL) is eligible for payment if the patient has one of the following
         medical indications:
        a. Mild to moderate progressive keratoconus;
        b. Corneal thinning or ectasia following laser photorefractive or phototherapeutic surgery;
        c. Pellucid marginal corneal degeneration; and
        d. Recurrent keratoconus after corneal transplantation.
  E202 Corneal cross-linking .............................................................. 200.00
      Payment rules:
      E202 is not eligible for payment for the same patient and performed on the same day as E117.

PDF page 769 / Y3

REPLACEMENT
    Corneal transplant
# E121 - penetrating .........................................................................      6     740.00    7
# E951   - with artificial prosthesis .............................................. add                   52.40
# E122 - lamellar...............................................................................    6     590.00    7
# E124 Limbal stem cell transplant .....................................................            6     740.00    8
# E123 Division of iris to cornea and/or angle.....................................                       161.75    6
      Payment rules:
      1.E117 is not eligible for payment with E124.
         2.E123 is not eligible for payment with E133, E132, E114, E115, E156 or E157
         3.E121 is eligible for payment for performing DSEK (Descemet's Stripping Endothelial
           Keratoplasty), DMEK (Descemet's Membrane Endothelial Keratoplasty) and DALK (Deep
           Anterior Lamellar Keratoplasty)
         4.E123 is only eligible for payment in addition to E121 under one of the following
           circumstances:
            a.Previous corneal transplantation,
            b.Post-operative corneal melt,
            c.Corneal perforation from trauma or infection, or
            d.Congenital conditions with iris corneal adhesions only when the iris adhesion is
               documented preoperatively and documented in the operative record.
         5.E117 is not eligible for payment with E121.

Master, record 945. Record Layout PDF, page 1.

E11720260401999999990000308300000000774600000000000000000095760000000957600

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.