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Cataract Surgery (CTRTSU) Episode Description

Version 1

An episode of care, also known as an episode, groups all relevant services provided to a patient for a particular condition within a confined time range. An episode of care serves as a unit of accounting as well as a unit of accountability for providers who take on financial risk for the episode. Defining an episode in such a manner helps to identify sources of variation and to standardize care.

An episode of care for Cataract Surgery, sometimes abbreviated CTRTSU, is a procedural episode. The Cataract Surgery episode includes services related to the procedure within the 30-day pre- and 90-day post-operative care time window, such as diagnostic services, (imaging, labs etc.), office visits, surgery itself and ancillary services.

Episode Components

Triggers
A Cataract Surgery episode trigger includes an outpatient facility or professional claim with a procedure trigger code in any position and a qualifying diagnosis code in any position on the same claim (Table 1).
Typical DiagnosisTypical diagnosis codes (ICD 10 DX codes) indicate typical care. Claims with typical diagnosis codes usually associated with an episode help steer services into this episode. However, a relevant procedure code is required on the same claim/claim line for the indicated diagnosis code to be incorporated into the episode. (Table 2)
Actionable adverse events (AAE)Actionable adverse events (AAE) are events that are recognized by diagnosis codes (ICD 10 DX codes) and their timing to indicate potential complications of care. They require a relevant procedure code (ICD 10 PX codes; CPT/HCPCS codes) on the same claim/claim line to assign the claim to the episode. Additional rules are used to identify AAEs in addition to the presence of AAE diagnosis codes. For example, relevant acute inpatient readmission claims are flagged as actionable adverse events regardless of the presence of AAE codes. (Table 3)
Relevant Procedure CodesAll relevant services within the timeframe of an episode are included within an episode. These include office visits, emergency room visits, inpatient professional or facility services, labs, radiology or ancillary services. Relevant diagnosis and procedure codes help identify which services are included. Some procedure codes are sufficient to stand alone, while others require typical or actionable adverse event (AAE) diagnosis codes on the same claim/claim line to steer services into the episode. (Tables 4 and 5)
Relevant PharmacyAll relevant pharmacy services are included within an episode. These are identified by National Drug Codes (NDC) on a pharmacy claim and are grouped using the RxNorm grouping classification for ease of assigning them into episodes. (Table 6)
SubTypesEpisode subtypes are used to adjust the target price and/or to subset episode type for reporting purposes. They are specific to the episode and identified from the trigger claim or from claims during the look-back period.
Examples of Subtype Groups: Remove Cataract and Implant Intraocular LensRemove Cataract without Implanting Intraocular LensHigh Risk Cataract Surgical Anatomy

Code Tables

Table 1: Trigger Codes
Trigger TypeCode Value
CPT / HCPCS Triggers0308T, 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984
ICD-10-CM (DX) Qualifying DiagnosisE0836, E0936, E1036, E1136, E1336, H25011, H25012, H25013, H25019, H25031, H25032, H25033, H25039, H25041, H25042, H25043, H25049, H25091, H25092, H25093, H25099, H2510, H2511, H2512, H2513, H2520, H2521, H2522, H2523, H25811, H25812, H25813, H25819, H2589, H259, H26001, H26002, H26003, H26009, H26011, H26012, H26013, H26019, H26031, H26032, H26033, H26039, H26041, H26042, H26043, H26049, H26051, H26052, H26053, H26059, H26061, H26062, H26063, H26069, H2609, H26101, H26102, H26103, H26109, H26111, H26112, H26113, H26119, H26121, H26122, H26123, H26129, H26131, H26132, H26133, H26139, H2620, H26211, H26212, H26213, H26219, H26221, H26222, H26223, H26229, H26231, H26232, H26233, H26239, H2630, H2631, H2632, H2633, H2640, H26411, H26412, H26413, H26419, H26491, H26492, H26493, H26499, H268, H269, H28, H53131, H53132, H53133, H53139, H540, H540X33, H540X34, H540X35, H540X43, H540X44, H540X45, H540X53, H540X54, H540X55, H5410, H5411, H541131, H541132, H541141, H541142, H541151, H541152, H5412, H541213, H541214, H541215, H541223, H541224, H541225, H542, H542X11, H542X12, H542X21, H542X22, H543, H5440, H5441, H54413A, H54414A, H54415A, H5442, H5442A3, H5442A4, H5442A5, H5450, H5451, H54511A, H54512A, H5452, H5452A1, H5452A2, H5460, H5461, H5462, H548, Q120, Q129
ICD-10-PCS (PX) Triggers085J3ZZ, 085K3ZZ, 08BJ3ZZ, 08BK3ZZ, 08DJ3ZZ, 08DK3ZZ

Table 2: ICD-10 Typical Diagnosis
Group IDGroup NameCode Value
DXX02141Blurred vision / DiplopiaH53041, H53042, H53043, H53049, H5371, H5372, H538, H539, H547, Z973
DXX02144AstigmatismH52201, H52202, H52203, H52209, H52211, H52212, H52213, H52219, H52221, H52222, H52223, H52229
DXX02157High risk cataract surgical anatomyH2181, H5703, H5709
DXX02158Mature or Hypermature CataractH25041, H25042, H25043, H25049, H2520, H2521, H2522, H2523, H25811, H25812, H25813, H25819, H2589
DXX02159Secondary CataractH2620, H26211, H26212, H26213, H26219, H26221, H26222, H26223, H26229, H26231, H26232, H26233, H26239, H2630, H2631, H2632, H2633, H26491, H26492, H26493, H26499, H28
DXX02162Traumatic CataractH26101, H26102, H26103, H26109, H26111, H26112, H26113, H26119, H26121, H26122, H26123, H26129, H26131, H26132, H26133, H26139
DXX02163Preglaucoma/Open Angle GlaucomaH4089, H409
DXX02164Secondary/Low Tension GlaucomaH4050X0, H4050X1, H4050X2, H4050X3, H4050X4, H4051X0, H4051X1, H4051X2, H4051X3, H4051X4, H4052X0, H4052X1, H4052X2, H4052X3, H4052X4, H4053X0, H4053X1, H4053X2, H4053X3, H4053X4
DXX02168Congenital CataractH26001, H26002, H26003, H26009, H26011, H26012, H26013, H26019, H26031, H26032, H26033, H26039, H26041, H26042, H26043, H26049, H26051, H26052, H26053, H26059, H26061, H26062, H26063, H26069, H2609, Q120, Q129
DXX02174CataractH25011, H25012, H25013, H25019, H25031, H25032, H25033, H25039, H25091, H25092, H25093, H25099, H2510, H2511, H2512, H2513, H259, H269
DXX02175Other visual impairmentH5310, H5311, H53121, H53122, H53123, H53129, H53141, H53142, H53143, H53149, H5319, H532, H5330, H5333
DXX02176Visual field defectsH5340, H53411, H53412, H53413, H53419, H53421, H53422, H53423, H53429, H53431, H53432, H53433, H53439, H53451, H53452, H53453, H53459, H53481, H53482, H53483, H53489
DXX02184Visual loss, blindnessH5441, H5442, H5451, H5452, H5461, H5462
DXX02187After CataractH26411, H26412, H26413, H26419
DXX0234Eye – refraction dsH4420, H4421, H4422, H4423, H5200, H5201, H5202, H5203, H5210, H5211, H5212, H5213, H5232, H524, H52521, H52522, H52523, H52529, H52531, H52532, H52533, H52539, H526, H527
DXX0240Eye – cataractZ961
DXX0258Eye – vision examZ0100, Z0101
DXX0262Eye – strabismus / relatedH5021, H5022
DXX0263Eye – vitreous opacitiesH43391, H43392, H43393, H43399
DXX0265Eye – other eye dsH579, Z460, Z9841, Z9842, Z9849, Z9883
DXX10102diabetes mellitus with ophthalmic manifestationsE0939, E1039, E1139, E1339
DXX10105Diabetic cataractE0836, E0936, E1036, E1136, E1336
DXX2159Toxic Effects of RadiationH268
DXX2350Othr – post-surgical states necZ978
DXX2370Fever & ChillsR509, R6883
DXX2374Residual codes, unclassifiedZ83518
DXX2379Observation/ExaminationZ0000, Z0189
DXX2381AftercareZ5189
DXX2382Preventive ScreeningZ135
XX0000Ungrouped CodesH54413A, H54414A, H54415A, H5442A3, H5442A4, H5442A5, H54511A, H54512A, H5452A1, H5452A2

Table 3: ICD-10 Actionable Adverse Events
Group IDGroup NameCode Value
DXX0020Superficial injury; contusionS0010XA, S0010XD, S0011XA, S0011XD, S0012XA, S0012XD, S0510XD, S0511XD, S0512XD, S0590XA
DXX02112Inj – cornea – foreign bodyT1500XA, T1501XA, T1502XA
DXX02113Inj – conjunctiva – foreign bodyT1510XA, T1511XA, T1512XA
DXX02114Inj – eye / adnexa – foreign bodyT1580XA, T1581XA, T1582XA, T1590XA, T1591XA, T1592XA
DXX02120acute eye infectionsH00031, H00032, H00033, H00034, H00035, H00036, H00039, H10011, H10012, H10013, H10019, H10021, H10022, H10023, H10029, H1010, H1011, H1012, H1013, H10211, H10212, H10213, H10219, H10221, H10222, H10223, H10229, H10231, H10232, H10233, H10239, H1030, H1031, H1032, H1033, H20051, H20052, H20053, H20059
DXX02122Acute infection of conjunctiva or eyelidsH01001, H01002, H01003, H01004, H01005, H01006, H01009, H01011, H01012, H01013, H01014, H01015, H01016, H01019, H01021, H01022, H01023, H01024, H01025, H01026, H01029, H10411, H10412, H10413, H10419, H1045, H10501, H10502, H10503, H10509, H10521, H10522, H10523, H10529, H10531, H10532, H10533, H10539
DXX02124Retinal ComplicationsG453, H34821, H34822, H34823, H34829, H3560, H3561, H3562, H3563
DXX02125Macular degenerationH35341, H35342, H35343, H35349, H35351, H35352, H35353, H35359, H35371, H35372, H35373, H35379, H35381, H35382, H35383, H35389, H35411, H35412, H35413, H35419
DXX02128Postprocedural BlebitisH5940, H5941, H5942, H5943
DXX02129Acute iridocyclitisH2000, H20011, H20012, H20013, H20019, H20021, H20022, H20023, H20029, H20031, H20032, H20033, H20039, H20041, H20042, H20043, H20049, H2020, H2021, H2022, H2023, H2100, H2101, H2102, H2103
DXX02130Corneal Edema and inflammationH16101, H16102, H16103, H16109, H16141, H16142, H16143, H16149, H16211, H16212, H16213, H16219, H16221, H16222, H16223, H16229, H169, H1810, H1811, H1812, H1813, H18211, H18212, H18213, H18219, H18231, H18232, H18233, H18239, H1840, H18421, H18422, H18423, H18429, H1849
DXX02133Dislocation of lensH2710, H27111, H27112, H27113, H27119, H27121, H27122, H27123, H27129, H27131, H27132, H27133, H27139, H278, H279
DXX02135Pain, swelling, redness of eyeH1130, H1131, H1132, H1133, H5710, H5711, H5712, H5713, H578
DXX02137Optic & Retrobulbar NeuritisH4600, H4601, H4602, H4603, H4610, H4611, H4612, H4613, H463, H468, H469
DXX02138Superficial Injury during eye surgeryS00221A, S00222A, S00229A, S0500XA, S0501XA, S0502XA
DXX02145Sudden or profound visual lossH53131, H53132, H53133, H53139, H543, H548
DXX02146Vitreous hemorrhage and degenerationH4300, H4301, H4302, H4303, H4310, H4311, H4312, H4313, H43811, H43812, H43813, H43819, H4389, H439
DXX02147Complications after eye surgeryH31301, H31302, H31303, H31309, H5060, H59011, H59012, H59013, H59019, H59021, H59022, H59023, H59029, H59031, H59032, H59033, H59039, H59091, H59092, H59093, H59099, H59111, H59112, H59113, H59119, H59121, H59122, H59123, H59129, H59211, H59212, H59213, H59219, H59221, H59222, H59223, H59229, H59311, H59312, H59313, H59319, H59321, H59322, H59323, H59329, H59331, H59332, H59333, H59339, H59341, H59342, H59343, H59349, H59351, H59352, H59353, H59359, H59361, H59362, H59363, H59369, S00201D, S00202D, S00209D, S00211D, S00212D, S00219D, S00251D, S00252D, T8521XA, T8521XD, T8522XA, T8522XD, T8529XA, T8529XD
DXX02149Endophthalmitis, other deep eye infectionsH15001, H15002, H15003, H15009, H15101, H15102, H15103, H15109, H44001, H44002, H44003, H44009, H44011, H44012, H44013, H44019, H44021, H44022, H44023, H44029, H44111, H44112, H44113, H44119, H44131, H44132, H44133, H44139, H4419
DXX02150Ptosis of eyeH02401, H02402, H02403, H02409, H02411, H02412, H02413, H02419, H02421, H02422, H02423, H02429, H02431, H02432, H02433, H02439
DXX02151Hypotony of eyeH4440, H44421, H44422, H44423, H44429, H44431, H44432, H44433, H44439
DXX02152Foreign body in eyeH44711, H44712, H44713, H44719, H44731, H44732, H44733, H44739, H44791, H44792, H44793, H44799, T1500XD, T1501XD, T1502XD, T1510XD, T1511XD, T1512XD, T1580XD, T1581XD, T1582XD, T1590XD, T1591XD, T1592XD
DXX02159Secondary CataractH2640
DXX02163Preglaucoma/Open Angle GlaucomaH40831, H40832, H40833, H40839
DXX02164Secondary/Low Tension GlaucomaH401410, H401411, H401412, H401413, H401414, H401420, H401421, H401422, H401423, H401424, H401430, H401431, H401432, H401433, H401434, H401490, H401491, H401492, H401493, H401494, H4040X0, H4040X1, H4040X2, H4040X3, H4040X4, H4041X0, H4041X1, H4041X2, H4041X3, H4041X4, H4042X0, H4042X1, H4042X2, H4042X3, H4042X4, H4043X0, H4043X1, H4043X2, H4043X3, H4043X4, H4060X0, H4060X1, H4060X2, H4060X3, H4060X4, H4061X0, H4061X1, H4061X2, H4061X3, H4061X4, H4062X0, H4062X1, H4062X2, H4062X3, H4062X4, H4063X0, H4063X1, H4063X2, H4063X3, H4063X4
DXX02171Corneal UlcerH16001, H16002, H16003, H16009, H16011, H16012, H16013, H16019, H16021, H16022, H16023, H16029, H16031, H16032, H16033, H16039, H16041, H16042, H16043, H16049, H16051, H16052, H16053, H16059, H16061, H16062, H16063, H16069, H16071, H16072, H16073, H16079
DXX02177Retinal DetachmentH33051, H33052, H33053, H33059, H338
DXX02181Ocular Prosthetic Device/Graft ComplicationT85318D, T85328D, T85398D
DXX02182Retinal Detachment, tear, defectsH33001, H33002, H33003, H33009, H33011, H33012, H33013, H33019, H33021, H33022, H33023, H33029, H33031, H33032, H33033, H33039, H3320, H3321, H3322, H3323, H33301, H33302, H33303, H33309, H33311, H33312, H33313, H33319, H33321, H33322, H33323, H33329, H33331, H33332, H33333, H33339, H3340, H3341, H3342, H3343
DXX02183Retinal Vascular OcclusionH3400, H3401, H3402, H3403, H3410, H3411, H3412, H3413, H34211, H34212, H34213, H34219, H34231, H34232, H34233, H34239, H34811, H348110, H348111, H348112, H34812, H348120, H348121, H348122, H34813, H348130, H348131, H348132, H34819, H348190, H348191, H348192, H34831, H348310, H348311, H348312, H34832, H348320, H348321, H348322, H34833, H348330, H348331, H348332, H34839, H348390, H348391, H348392, H349, H3540
DXX02184Visual loss, blindnessH540, H5410, H5411, H5412, H542, H5440, H5450, H5460
DXX0268Eye – dry eyesH04121, H04122, H04123, H04129
DXX05297Hypotension / SyncopeI952, I9581, I959, R55
DXX05375DehydrationE860, E861, E869
DXX09187Wound InfectionsT814XXA
DXX09190Wound DehiscenceT8130XA, T8131XA, T8132XA
DXX1849Other bacterial infectionsR899
DXX1850MRSA, Drug Resistant InfectionsA4902, B9562, Z1610, Z1611, Z1612, Z1619, Z1620, Z1621, Z1622, Z1623, Z1624, Z1629, Z1630, Z1635, Z1639
DXX2104NS – acute pain – post opG8918
DXX2171Adverse effects of drugsG4440, G4441, K1232, R502, T360X5A, T360X5D, T361X5A, T361X5D, T362X5A, T362X5D, T363X5A, T363X5D, T364X5A, T364X5D, T365X5A, T365X5D, T366X5A, T366X5D, T367X5A, T367X5D, T368X5A, T368X5D, T3695XA, T3695XD, T370X5A, T370X5D, T371X5A, T372X5A, T373X5A, T374X5A, T375X5A, T378X5A, T378X5D, T3795XA, T3795XD, T39015A, T39015D, T39095A, T39095D, T391X5A, T391X5D, T392X5A, T392X5D, T39315A, T39315D, T39395A, T39395D, T394X5A, T394X5D, T398X5A, T398X5D, T3995XA, T3995XD, T400X5A, T400X5D, T402X5A, T402X5D, T403X5A, T403X5D, T404X5A, T404X5D, T40605A, T40605D, T40695A, T40695D, T410X5D, T411X5D, T41205D, T41295D, T413X5D, T4145XD, T423X5A, T423X5D, T424X5A, T424X5D, T450X5A, T450X5D, T452X5A, T452X5D, T453X5A, T453X5D, T454X5A, T454X5D, T45515A, T45515D, T457X5A, T457X5D, T471X5A, T471X5D, T472X5A, T472X5D, T473X5A, T473X5D, T474X5A, T474X5D, T475X5A, T475X5D, T476X5A, T476X5D, T477X5A, T477X5D, T483X5A, T483X5D, T484X5A, T484X5D, T485X5A, T485X5D, T486X5A, T486X5D, T495X5A, T495X5D, T498X5A, T498X5D, T4995XA, T4995XD, T500X5A, T500X5D, T501X5A, T501X5D, T502X5A, T502X5D, T508X5A, T508X5D, T50905A, T50905D, T50995A, T50995D
DXX2175Complications of anesthesiaT410X5A, T411X5A, T41205A, T41295A, T413X5A, T4145XA, T8852XA, T8853XA, T8859XA, Y700, Y701, Y702, Y703, Y708
DXX2354Othr – aftercareS00221D, S00222D, S00229D, S00241D, S00242D, S00249D, S01101D, S01102D, S01109D, S04011D, S04012D, S04019D, S04031D, S04032D, S04039D, S04041D, S04042D, S04049D, S0500XD, S0501XD, S0502XD, S0520XD, S0521XD, S0522XD, S0530XD, S0531XD, S0532XD
DXX2361complications of surgical proceduresT81718D, T81719D, T8172XD, T8182XD, T8189XD, T819XXA, T819XXD, T888XXA, T888XXD, Y628, Y629, Y652, Y6551, Y6552, Y6553, Y710, Y740, Y741, Y742, Y743, Y748, Y770, Y771, Y772, Y773, Y778, Y780, Y781, Y782, Y783, Y788, Y800, Y801, Y802, Y803, Y808
DXX2362complications of medical careY635, Y636, Y638, Y639, Y641, Y648, Y649
XX0000Ungrouped CodesH0100A, H0100B, H0101A, H0101B, H02151, H02152, H02153, H02154, H02155, H02156, H02159, H0220A, H0220B, H0220C, H0221A, H0221B, H0221C, H0222A, H0222B, H0222C, H0223A, H0223B, H0223C, H02881, H02882, H02883, H02884, H02885, H02886, H02889, H0288A, H0288B, H442A1, H442A2, H442A3, H442A9, H442B1, H442B2, H442B3, H442B9, H442C1, H442C2, H442C3, H442C9, H442D1, H442D2, H442D3, H442D9, H442E1, H442E2, H442E3, H442E9, H540X33, H540X34, H540X35, H540X43, H540X44, H540X45, H540X53, H540X54, H540X55, H541131, H541132, H541141, H541142, H541151, H541152, H541213, H541214, H541215, H541223, H541224, H541225, H542X11, H542X12, H542X21, H542X22, H5789, T8140XA, T8140XD, T8141XA, T8141XD, T8142XA, T8142XD, T8143XA, T8143XD, T8144XA, T8144XD, T8149XA, T8149XD

Table 4: ICD-10 Relevant Procedure Codes
Group IDGroup NameCode Value
PXX0215Lens and cataract procedures – 015085J3ZZ, 085J3ZZ, 085K3ZZ, 085K3ZZ, 089J30Z, 089J3ZX, 089J3ZZ, 089K30Z, 089K3ZX, 089K3ZZ, 08BJ3ZX, 08BJ3ZZ, 08BJ3ZZ, 08BK3ZX, 08BK3ZZ, 08BK3ZZ, 08DJ3ZZ, 08DK3ZZ, 08PJ3JZ, 08PK3JZ, 08QJ3ZZ, 08QK3ZZ, 08RJ30Z, 08RJ37Z, 08RJ3JZ, 08RJ3KZ, 08RK30Z, 08RK37Z, 08RK3JZ, 08RK3KZ, 08SJ3ZZ, 08SK3ZZ, 08TJ3ZZ, 08TK3ZZ, 08WJ3JZ, 08WK3JZ
PXX0216Repair of retinal tear, detachment – 01608QE3ZZ, 08QF3ZZ, 3E0C3GC, 3E0CXSF
PXX0218Diagnostic procedures on eye – 0180890XZX, 0891XZX, 08943ZX, 08953ZX, 0898XZX, 0899XZX, 089A0ZX, 089A3ZX, 089B0ZX, 089B3ZX, 089E3ZX, 089F3ZX, 089G3ZX, 089H3ZX, 089L0ZX, 089L3ZX, 089M0ZX, 089M3ZX, 089N0ZX, 089N3ZX, 089NXZX, 089P0ZX, 089P3ZX, 089PXZX, 089Q0ZX, 089Q3ZX, 089QXZX, 089R0ZX, 089R3ZX, 089RXZX, 089SXZX, 089TXZX, 089V0ZX, 089V3ZX, 089W0ZX, 089W3ZX, 089X0ZX, 089X3ZX, 089X7ZX, 089X8ZX, 089Y0ZX, 089Y3ZX, 089Y7ZX, 089Y8ZX, 08B00ZX, 08B03ZX, 08B0XZX, 08B10ZX, 08B13ZX, 08B1XZX, 08B43ZX, 08B53ZX, 08B8XZX, 08B9XZX, 08BA0ZX, 08BA3ZX, 08BB0ZX, 08BB3ZX, 08BE3ZX, 08BF3ZX, 08BL0ZX, 08BL3ZX, 08BM0ZX, 08BM3ZX, 08BN0ZX, 08BN3ZX, 08BNXZX, 08BP0ZX, 08BP3ZX, 08BPXZX, 08BQ0ZX, 08BQ3ZX, 08BQXZX, 08BR0ZX, 08BR3ZX, 08BRXZX, 08BSXZX, 08BTXZX, 08BV0ZX, 08BV3ZX, 08BW0ZX, 08BW3ZX, 08BX0ZX, 08BX3ZX, 08BX7ZX, 08BX8ZX, 08BY0ZX, 08BY3ZX, 08BY7ZX, 08BY8ZX, 08D8XZX, 08D8XZZ, 08D9XZX, 08D9XZZ, 08J0XZZ, 08J1XZZ, 08JJXZZ, 08JKXZZ, 08JL0ZZ, 08JLXZZ, 08JM0ZZ, 08JMXZZ, 0N9P0ZX, 0N9P3ZX, 0N9P4ZX, 0N9Q0ZX, 0N9Q3ZX, 0N9Q4ZX, 0NBP0ZX, 0NBP3ZX, 0NBP4ZX, 0NBQ0ZX, 0NBQ3ZX, 0NBQ4ZX
PXX0219Other therapeutic procedures on eyelids, conjunctiva, cornea – 01908P0XJZ, 08P1XJZ, 3E0C33Z, 3E0C3BZ, 3E0C3HZ, 3E0C3KZ, 3E0C3TZ, 3E0C729, 3E0C73Z, 3E0C7BZ, 3E0C7GC, 3E0C7HZ, 3E0C7KZ, 3E0C7SF, 3E0C7TZ, 3E0CX29, 3E0CX3Z, 3E0CXBZ, 3E0CXGC, 3E0CXHZ, 3E0CXKZ, 3E0CXTZ
PXX0220Other intraocular therapeutic procedures – 020085G3ZZ, 085H3ZZ, 089A00Z, 089A0ZZ, 089A30Z, 089A3ZZ, 089B00Z, 089B0ZZ, 089B30Z, 089B3ZZ, 089E30Z, 089E3ZZ, 089F30Z, 089F3ZZ, 089G30Z, 089G3ZZ, 089H30Z, 089H3ZZ, 08CG3ZZ, 08CH3ZZ, 08NA0ZZ, 08NA3ZZ, 08NB0ZZ, 08NB3ZZ, 08NE3ZZ, 08NF3ZZ, 08NG3ZZ, 08NH3ZZ, 08QA0ZZ, 08QA3ZZ, 08QB0ZZ, 08QB3ZZ, 08QG3ZZ, 08QH3ZZ, 08RG37Z, 08RG3JZ, 08RG3KZ, 08RH37Z, 08RH3JZ, 08RH3KZ, 08SG3ZZ, 08SH3ZZ, 08UG07Z, 08UG0JZ, 08UG0KZ, 08UG37Z, 08UG3JZ, 08UG3KZ, 08UH07Z, 08UH0JZ, 08UH0KZ, 08UH37Z, 08UH3JZ, 08UH3KZ, 3E0C3SF
PXX0221Other extraocular muscle and orbit therapeutic procedures – 0213E0C329
PXX02220Ophthalmologic and otologic diagnosis and treatment – 2204A07X0Z, 4A07X7Z, 4A07XBZ, B803ZZZ, B804ZZZ, B805ZZZ, B806ZZZ, B807ZZZ, B845ZZZ, B846ZZZ, B847ZZZ, C8191ZZ, C819YZZ, C81YYZZ, F0DZ8UZ

Table 5: Relevant Procedure Codes CPT/HCPCS
Group IDGroup NameCode Value
CT0025Preventive Medicine, Care Coordination98966, 98967, 98968, 99366, 99367, 99368, 99396, 99441, 99442, 99443, 99446, 99447, 99448, 99449, 99499
CT0026Pain medsJ3010
CT0089Metabolic Renal Hepatic Chemistry Panel80047, 80048, 80050, 80053
CT0091Physician Services – Outpatient 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99354, 99355
CT01395DME and suppliesC1840
CT0141Rx – central nervous system – benzodiazepinesJ2250
CT0163Tests – neuro – evoked potentials95930
CT0206Procedure – lens / cataract – laser posterior capsulotomy66821, 66821
CT0207Procedure – lens / cataract – other65920, 66820, 66820, 66825, 66830, 66830, 66985, 66985, 66986, 66986
CT0208Procedure – lens / cataract – iolC1780, Q1004, Q1005, V2630, V2631, V2632
CT0209Procedure – retinal tear / detachment – scleral buckling w and w / o vitrectomy67107, 67108
CT0210Procedure – retinal tear / detachment – vitrectomy w /  laser photocoagulation67039, 67041, 67042, 67043
CT0211Procedure – retinal tear / detachment – prophylaxis – laser / related67141, 67145
CT0212Procedure – retinal tear / detachment – other67101, 67105, 67110, 67112
CT0215Procedure – other intraocular rx – other65265, 65810, 65815, 65860, 65865, 65870, 65875, 65880, 65900, 65930, 66020, 66030, 66130, 66220, 66225, 66990, 66999, 67005, 67010, 67015, 67025, 67028, 67030, 67031, 67036, 67115, 67120, 67121, 67250, 67255, 67299
CT0216Procedure – eye – biopsy or exploration65410, 65430, 65800, 67415, 67810, 68100, 68510, 68525
CT0222Procedure – rx on eyelids / conjunctiva / cornea – other66250
CT0224Procedure – other eye procedures – other67500, 67505
CT0225Procedure – eye – other implants / suppliesC1784, C1814, V2787, V2788
CT0227Other care – vision – service92310, 92311, 92312, 92313, 92314, 92315, 92316, 92317, 92325, 92326, 92340, 92341, 92342, 92352, 92353, 92354, 92355, 92358, 92370, 92371, S0592
CT0229Other care – vision – eyeglass lens – trifocalV2300, V2303
CT0231Other care – vision – eyeglass lens – bifocalV2200, V2203
CT0232Other care – vision – eyeglass lensV2755
CT0236Other care – vision – framesV2020
CT0238Imaging – us – eye76510, 76511, 76512, 76513, 76514, 76516, 76519, 76529
CT02386Ophthalmologic and otologic diagnosis and treatment99177
CT02389Glaucoma procedures0191T
CT0239Imaging – venography – other75880
CT0240Tests – eye – exam99172, 99173, S0620, S0621
CT0243Tests – eye – sensorimotor evaluation92060
CT0244Tests – eye – orthoptic / peoptic training92065
CT0248Tests – eye – retinal exam92133, 92134, S3000
CT0251Tests – eye – dx – other92015, 92136, 92240, 92260, 92265, 92270, 92275, 92283, 92284, 92285, 92286, 92287, 92499
CT0253Surgery For Glaucoma66682
CT0254Cataract Surgery w lens implant0308T, 66982, 66983, 66984
CT0255Removal of lens material wout lens implant66840, 66850, 66852, 66920, 66930, 66940
CT0256Eye Exam2020F, 92002, 92004, 92012, 92014, 92225, 92226, 92227, 92228, 92230, 92235, 92250
CT0257Other Eye Services, Glaucoma 92018, 92019, 92020, 92025, 92081, 92082, 92083, 92100, 92132, 92140, G0117, G0118
CT05307Electrocardiogram – EKG monitoring93000, 93005, 93010
CT10296Low dose steroidsJ1720
CT16297Blood Count85025, 85027, G0306, G0307
CT16299Bleeding Status85610
CT23398Ancillary Services99415, 99416
CT9904E & M – emergency care99283, 99284, 99285
CT9908E & M – other99488
CT9910Procedure – anesthesia01999, 99100
CT99169Lab – specimen collection – blood – venous – venipuncture36415
CT99191SuppliesA6410, A6411, A6412
CT99198PQRIG8398
CT9924Procedure – related supplies – implantC1783
CT9932Therapy – nonoperative removal of foreign body65235
CT99392Other diagnostic procedures (interview, evaluation, consultation)G0438, G0439
CT9940Therapy – other99024
CT99408Chronic Care Management99487, 99489
CT99415Physician Services – Outpatient 99358, 99359
CT99416Procedures and Reporting99080, 99090, 99091
CT9960Rx – miscellaneous rx – anesthetics, localJ2001, J2400, S0020
XX0000Ungrouped Codes00140, 00142, 00145, 00148, 0014F, 0308T, 0329T, 0376T, 0378T, 0379T, 0444T, 0445T, 1055F, 3073F, 3120F, 3325F, 33952, 33954, 33958, 33962, 33966, 33984, 4175F, 4176F, 6030F, 92071, 92072, 92145, 92242, 99152, 99153, 99156, 99157, 99451, 99452, 99453, 99454, 99457, C1841, C1842, C9443, C9444, C9446, C9447, G0472, G0473, G0913, G0915, G0916, G0918, G6045, G6046, G8627, G8628, G8704, G8765, G8906, G9362, G9363, G9391, G9392, G9497, G9519, G9520, G9540, G9644, G9645, J2274, J2704, Q9974, S0144

Table 6: Relevant Typical Drug Groups
Group IDGroup Name
RX016antimigraine preparations
RX017hypnotics and sedatives
RX0212mydriatics and cycloplegics
RX0213ocular vascular disorder agents
RX0215ophthalmologicals – anesthetics  local
RX0216ophthalmologicals – antiinfectives
RX0219other ophthalmologicals
RX0220ophthalmologicals – antiallergics
RX0221ophthalmologicals steroids & antiinflammatory
RX0857antiinflammatory and antirheumatic products
RX0861opioids
RX0862other analgesics and antipyretics
RX0971antiseptics and disinfectants
RX0976irrigating solutions
RX0977medicated dressings
RX0979preparations for treatment of wounds and ulcers
RX16108other hematological agents
RX18117antibacterials for systemic use
RX18119antiinfectives
RX19125anxiolytics
RX99136anesthetics  general
RX99137anesthetics  local
RX99138medical gas

These materials represent Version 1 of Signify Health Episode Definition Library and are comprised of copyrighted material of Signify Health and Health Care Incentives Improvement Institute, Inc.

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