# Confusing Cataract



## codedog (Jan 5, 2012)

Not sure how to code this report because of no lens at final procedure, ? any suggestions ?

PREOPERATIVE DIAGNOSES:	1.	White mature cataract.
	2.	Small pupil with synechial adhesions to the lens capsule.
3.	Hypotony.
4.	Retina detachment from trauma.

POSTOPERATIVE DIAGNOSES:	1.	White mature cataract.
	2.	Small pupil with synechial adhesions to the lens capsule.
3.	Hypotony.
4.	Retina detachment from trauma.
5.	Zonular dehiscence with intraocular lens slipping into the vitreous cavity with subluxation of the intraocular lens.

PROCEDURES PERFORMED:	1.	Phacoemulsification with implantation of the posterior chamber intraocular lens.
2.	Pupilloplasty of the synechiolysis to enlarge the pupil.
3.	Removal of the intraocular lens because of zonular dehiscence.
4.	Removal of the capsular bag again because of zonular dehiscence.

ANESTHESIA:	MAC.

COMPLICATIONS:	Nil.

DESCRIPTION OF PROCEDURE:  Informed consent was obtained from the patient.  The patient was wheeled into the operating room.  He was anesthetized using endotracheal general anesthesia techniques.  The right eye was prepped and draped in a standard fashion for this procedure.  Lids and eyelashes were secured with the help of a lid speculum.  Preservative-free lidocaine, one drop x3 was placed on the surface of the cornea and the conjunctiva.  Examination of the anterior segment was performed with microscope.  Please note that the cornea was clear.  However, the anterior chamber was shallow, but formed.  The pupil was measured approximately 2.5 mm with synechial adhesions that were visible between the pupillary margin at the lens capsule and there was a white cataract with no red reflex.  The eye was also extremely soft.  A paracentesis was performed in the inferotemporal quadrant.  Viscoelastic was injected into the anterior chamber.  A 2.75-mm Alcon keratome was used to enter the anterior chamber and the temporal quadrant.  Using the viscoelastic cannula, the synechiolysis was performed.  This was followed by staining of the anterior capsule of the cataract with the help of VisionBlue.  This was followed by the continuous capsulorhexis.  The white milky cataract was easily removed with the help of aspiration techniques.  This was followed by removal of the remaining cortical material.  The bag was examined and there was found to have a dense posterior subcapsular opacity.  An attempt was made to scrape it off, but would not come out.  So, the posterior capsular opacity was left behind.  Please note that the bag was completely intact at this stage.  The posterior chamber intraocular lens was inserted into the capsular bag.  As soon as the intraocular lens started unfolding, it appears that a zonular dehiscence was clearly visible with the lens tipping posteriorly along with the bag into the vitreous cavity.  Please note that the patient had silicone oil from the previous retinal surgeries and that started coming forward.  Because of the unstable cataractous bag with zonular dehiscence extending more than 180 degrees and then intraocular lens that is tilted posteriorly, I felt it was necessary to remove the intraocular lens.  Using the Sinskey hook, the intraocular lens was dialed out of the bag into the anterior chamber.  The wound itself was enlarged approximately 4 mm.  The haptic was dialed out followed by cutting the intraocular lens and splitting the intraocular lens into two halves using a Vannas scissors.  The two halves of the intraocular lens were then removed from the anterior chamber.  The capsular bag itself was easily removed in total mostly using the Utrata forceps.  The small quantity of silicone that came into the anterior chamber was washed out.  The wound was closed with the help of a three interrupted 10-0 nylon sutures.  This was followed by injection of 0.1 cc of Decadron into the anterior chamber along with BSS to pump the pressure inside the eye.  At the end of the procedure, the cornea was clear.  The anterior chamber was deep and well formed.  The patient was left aphakic and there was still no red reflex because of detached retina in the bag.  The patient was successfully extubated from general anesthesia, endotracheal techniques, and transferred to the recovery room without any other complications.

maybe 66984 but no lens in was in


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## nbrau (Jan 5, 2012)

Take a look at CPT codes 66840 - 66940.  These codes are for cataract extraction without lens insertion.  You can also reference CPT assistant September 2009.


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## codedog (Jan 5, 2012)

I was thinking of 66840 , but he  did put lens in ,then took it out , Can I code 66984 with 66840 ?, on the same  day ?Not sure, I dont think I can , but not sure


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## codedog (Jan 19, 2012)

I was told to use 66982 with 66986 , how can you use 66986 -which is a lens  exchange, no lens  wasreplace


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## codedog (Feb 6, 2012)

would cpt code 66982 with 66850 ?would this work


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## bethh05 (Feb 6, 2012)

66982 and 66850 bundle. What about 66982-52, since the planned procedure was Cataract removal and lens placement. This is a tuff one.


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