Fee Navigator

    Health Service Code 21.31A

    Diagnostic irrigation of nasolacrimal duct, office procedure, per eye

    Category:M Minor Procedure
    Base rate:$31.33

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CALLNBRSER1For Each Call Pay Base At100%
    CALLNBRSER2 - 2For Each Call Pay Base At75%
    TRAYMINTIncrease By$13.11
    NBTRNBTRYes
    LVPLVP75YesReduce Base To75%

    Governing Rules:

    • 6.1

      If a physician performs a minor procedure and provides a service warranting a claim for an office visit or a home visit on the same day, benefits for both may be claimed only if the services and diagnoses are unrelated.

    • 6.2

      If a service is provided in a hospital emergency department, AACC or UCC, only the minor procedure or the visit benefit, whichever is the greater, may be claimed, unless the problems are emergencies and the diagnoses are unrelated.

    • 6.7.1

      If a minor procedure (M or M+) is provided with a hospital visit on the same day, only the greater benefit HSC may be claimed.

    • 9.1.2

      Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.04A, 03.08A, 03.08H and 09.04:

      • 09.01B Gonioscopy
      • 09.01C Orthoptic analysis, interpretation
      • 09.01E Orthoptic analysis, technical (may include Hess screen)
      • 09.02B Anterior chamber depth measurement
      • 09.02E Amblyopia evaluation for patients nine years of age or younger
      • 09.05A Full threshold perimetric examination, technical
      • 09.05B Full threshold perimetric examination, interpretation
      • 09.06A Color vision test, interpretation and technical

      09.11A Bilateral specular microscopy for corneal graft patients only - technical 09.11B Bilateral specular microscopy for corneal graft patients only - interpretation 09.11C Potential acuity measurement (PAM) 09.12A Intravenous fluorescein angiography (IVFA), interpretation 09.12B Intravenous fluorescein angiography (IVFA), technical 09.13E Optical coherence tomography (OCT), interpretation 09.13F Optical coherence tomography (OCT), technical 09.26A Diurnal tension curve 09.26D Bilateral corneal pachymetry 21.31A Diagnostic irrigation of nasolacrimal duct, office procedure, per eye 24.89B Diagnostic conjunctival scraping 25.81A Diagnostic corneal scraping

    • 9.1.3

      Three technical services and three interpretive services from the following examinations may be claimed in addition to HSCs 03.02A, 03.03A, 03.07A and 03.07B:

      • 03.12A Intraocular pressure measurement
      • 09.01A Biomicroscopy (slit lamp examination)
      • 09.01B Gonioscopy
      • 09.01C Orthoptic analysis, interpretation
      • 09.01E Orthoptic analysis, technical (may include Hess screen)
      • 09.02B Anterior chamber depth measurement
      • 09.02E Amblyopia evaluation for patients nine years of age or younger
      • 09.05A Full threshold perimetric examination, technical
      • 09.05B Full threshold perimetric examination, interpretation
      • 09.06A Color vision test, interpretation and technical
      • 09.11A Bilateral specular microscopy for corneal graft patients only - technical
      • 09.11B Bilateral specular microscopy for corneal graft patients only - interpretation
      • 09.11C Potential acuity measurement (PAM)
      • 09.12A Intravenous fluorescein angiography (IVFA), interpretation
      • 09.12B Intravenous fluorescein angiography (IVFA), technical
      • 09.13E Optical coherence tomography (OCT), interpretation
      • 09.13F Optical coherence tomography (OCT), technical
      • 09.26A Diurnal tension curve
      • 09.26D Bilateral corneal pachymetry
      • 21.31A Diagnostic irrigation of nasolacrimal duct, office procedure, per eye
      • 24.89B Diagnostic conjunctival scraping
      • 25.81A Diagnostic corneal scraping
    • 9.1.4

      When done independently on a separate day or as a repeat, not more than three interpretations and three technical services from the list in GR 9.1.3 may be claimed.

    • 9.1.6

      Unless otherwise specified, the HSCs listed under GR 9.1.2 and 9.1.3 include both the technical and interpretive components.

    • 14.2 MINOR TRAY SERVICE

      A minor tray service benefit may be claimed for the following procedures only when they are performed in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services.

    • 14.3 MULTIPLE TRAY SERVICE

      If multiple procedures listed under GRs 14.1 and 14.2 are performed during the same encounter in a location other than a nursing home, general or auxiliary hospital, AACC, UCC or a facility which has a contract with a regional health authority to provide any of these insured services, the following applies:

    • 14.3.1

      For the same anatomical area (example - 3 moles removed from the face), only one tray may be claimed except when the condition relates to suspected cancer or infection, in which case, if required, additional tray(s) may be claimed at 50%.

    • 14.3.2

      For different anatomical areas, the tray for the initial procedure may be claimed at 100% and if required, the tray for each additional procedure may be claimed at 50%.

    • 14.3.3

      Benefits for additional trays may not exceed the benefit listed for one major tray.