100 |
CLINICAL assessment only
Intraretinal tumor(s) with subretinal fluid
- Equal to but not greater than 3 millimeter (mm)
- AND Location not closer than 1.5 mm to optic disk or fovea |
L |
125 |
CLINICAL assessment only
Intraretinal tumor(s) with subretinal fluid
- Greater than 3 millimeter (mm)
- AND Location closer than 1.5 mm from disc or fovea |
L |
150 |
CLINICAL assessment only
Intraretinal tumor(s) with subretinal fluid ≤5 mm from the base of any tumor
Tumor confined to retina, NOS
Localized, NOS |
L |
175 |
PATHOLOGICAL assessment only
Intraocular tumor(s) WITHOUT any
- Local invasion
- Focal choroidal invasion
- Pre- or intralaminar involvement of the optic nerve head
Tumor confined to retina, NOS
Localized, NOS |
L |
200 |
CLINICAL assessment only
Intraocular tumor(s) WITH
- Subretinal fluid greater than 5 mm [0.5 cm] from base of tumor
- WITH or WITHOUT retinal detachment |
L |
225 |
CLINICAL assessment only
Intraocular tumor(s) WITH
- Vitreous seeding and/or subretinal seeding
- WITH or WITHOUT retinal detachment |
L |
250 |
PATHOLOGICAL assessment only
Intraocular tumor(s) WITH local invasion
- Concomitant focal choroidal invasion
- AND pre- or intralaminar involvement of optic nerve head |
L |
275 |
PATHOLOGICAL assessment only
Intraocular tumor(s) WITH local invasion
Stromal invasion iris
- AND/OR trabecular meshwork
- AND/OR Schlemm's canal |
L |
300 |
Intraocular tumor(s) WITH local invasion, NOS
Intraocular tumor(s) with retinal detachment, vitreous seeding, or subretinal seeding, NOS |
L |
325 |
CLINICAL assessment only
Advanced intraocular tumor(s) WITH
- Phthisis or pre-phthisis bulbi |
L |
350 |
PATHOLOGICAL assessment only
Intraocular tumor(s) WITH significant local invasion
- Massive choroidal invasion (greater than 3 mm [0.3 cm] in largest diameter)
- OR multiple foci or focal choroidal involvement (greater than 3 mm)
- OR full-thickness choroidal involvement |
L |
375 |
CLINICAL assessment only
Advanced intraocular tumor(s) WITH invasion of
- Anterior chamber
- Choroid
- Ciliary body
- Iris
- Lens
- Pars plana
- Zonules |
L |
400 |
PATHOLOGICAL assessment only
Intraocular tumor(s) WITH significant local invasion
- Retrolaminar invasion of optic nerve head
- NOT involving transected end of optic nerve |
L |
425 |
CLINICAL assessment only
Advanced intraocular tumor(s) WITH
- Raised intraocular pressure with neovascularization
- AND/OR buphthalmos |
L |
450 |
PATHOLOGICAL assessment only
Intraocular tumor(s) WITH significant local invasion
- Any partial-thickness involvement of sclera within inner two thirds |
L |
475 |
CLINICAL assessment only
Advanced intraocular tumor(s) WITH
- Hyphema AND/OR massive vitreous hemorrhage |
L |
500 |
PATHOLOGICAL assessment only
Advanced intraocular tumor(s) WITH
- Full-thickness invasion into outer third of sclera
- AND/OR invasion into or around emissary channels |
L |
525 |
CLINICAL assessment only
Advanced intraocular tumor(s) WITH
- Aseptic orbital cellulitis |
L |
550 |
Advanced intraocular tumor(s) WITH significant local invasion |
L |
600 |
CLINICAL assessment only
Extraocular tumor(s) involving orbit
- Radiologic evidence of retrobulbar optic nerve involvement
- OR thickening of optic nerve and/or orbital tissues |
RE |
650 |
CLINICAL assessment only
Extraocular tumor(s) involving orbit, including optic nerve
- WITH proptosis AND/OR an orbital mass |
RE |
700 |
CLINICAL assessment only
Extraocular tumor(s) involving orbit, including optic nerve, NOS |
RE |
750 |
PATHOLOGICAL assessment only
Evidence of extraocular tumor
- Tumor at transected end of optic nerve
- Tumor in the meningeal spaces around optic nerve
Full-thickness invasion of sclera WITH invasion of
- Adjacent adipose tissue
- Bone
- Conjunctiva
- Episclera
- Extraocular muscle
- Eyelids |
RE |
800 |
No evidence of primary tumor |
U |
999 |
Unknown; extension not stated
Primary tumor cannot be assessed
Not documented in medical record
Death Certificate Only |
U |