# IOL lens exchange



## smcbroom (Aug 22, 2008)

Since I'm still new to coding opthalmology, I need some assistance with this one.  I'm not sure if it's just the 66986 code and what code do I use for the lens replacement since I can't find a HCPCS code for it. Here is the op report....

PREOPERATIVE DIAGNOSES:  
Dislocated intraocular lens, left eye.

POSTOPERATIVE DIAGNOSES:
Dislocated intraocular lens, left eye.

OPERATION:
Intraocular lens exchange, left eye.


COMPLICATIONS:
None.

ESTIMATED BLOOD LOSS:
Less than 1 cc.

ANESTHESIA:
Topical with MAC

DESCRIPTION OF PROCEDURE:
After appropriate consents were obtained, the patient was brought to the operating room and prepped and draped in the usual sterile fashion for ophthalmology.  A lid speculum was placed in the left eye and a Supersharp was used to make a stab incision at the 2 o'clock position through which 2% preservative-free Xylocaine was injected followed by viscoelastic.  The viscoelastic was injected also posterior to the funda and IOL and in an attempt to float the IOL anteriorly.  Westcott scissors were used to make a superior peritomy approximately 6-mm and a 2.75-mm keratome was then used to make a limbal 6-mm incision.  Forces were used to grasp the IOL by the superior haptic.  This was then pulled through this enlarged wound and out of the eye.

A stitch that had been previously placed to anchor the IOL in the iris was cut and removed and cautery was performed along the scleral edge to control any bleeding.  Provisc was injected into the anterior chamber after Miostat was injected to shrink the pupil.  A vitrectomy was used to make a PI at the superior position just nasal.  This was performed without difficult and an MTA4UO 16.0-diopter lens was then placed through this primary incision on top of the iris into the anterior chamber and then rotated horizontally.  This was tolerated well without difficulty and three interrupted 10-0 nylon sutures were then placed superiorly for hydrostasis.

Provisc was then used to verify that there were no leakage of the anterior chamber and a single 10?0 Vicryl stitch was placed to close the peritomy previously performed with Westcott.  At the conclusion of the case, the anterior chamber was well formed, IOL was well centered, and no leaks were appreciated.  Pred Forte, Zymar, and Timoptic were placed in the eye followed by Mastisol ointment.  The patient was then followed to recovery where she was noted to be in good condition.

Any help would be appreciated!


----------



## drakena74 (Sep 15, 2008)

*IOL exchange*

There is no HCPCS for IOL exchange.  If you work for Ophthalmology office, you only bill for the surgery.  The Hopital or Outpatient surgery center would bill for the lens.


----------



## mbort (Sep 16, 2008)

smcbroom...You code for an ASC right?  Is this a Medicare patient?


----------



## smcbroom (Sep 16, 2008)

I actually got my answer but thanks anyway MBort!


----------

