Ophthalmology and Optometry Coding Alert

Look carefully at the op report before reaching for 66982.

Myth: You should report the code for complex cataract removals (66982) every time your ophthalmologist says that a difficult cataract surgery was performed.

Reality: You can only report 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation) in very specific circumstances.

To get the lowdown on how to determine if — and when — you should report 66982, check out the following tips.

4 Questions Point the Way to 66982

Ask yourself these questions when you’re deciding whether to report 66982:

• Is the pupil miotic?
• Is the patient very young, and still in the amblyogenic developmental stage?
• Does the IOL need extra support, such as permanent intraocular sutures or capsular tension rings?
• Does the ophthalmologist need to use dye to visualize the anterior chamber?

If the answers are “yes,” you may be able to report 66982 instead of the lower-reimbursing 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation) for an extracapsular cataract removal. However, it’s still not guaranteed.

Payment for 66982, based on the 2021 Medicare Physician Fee Schedule, is about $750, compared to $548 for 66984. Therefore, correctly using this code could net your practice about 26 percent more income — but only if you use it correctly. Applying 66982 in the wrong way could set you up for audits and refund requests.

Complications, Lens Insertions Aren’t Enough

Watch out: Don’t report 66982 just because the ophthalmologist encounters a surgical complication, such as the need to perform a vitrectomy. In addition, even though the descriptor for 66982 mentions an intraocular lens, that alone is not enough to justify the code, since the descriptor refers to “suture support for intraocular lens.”

“It would be the suture support that elevates the procedure from 66984 to 66982,” says Brett Rosenberg, MA, CPC, CCS-P, COC, VILT faculty manager with the American Academy of Professional Coders.

In black and white: “The billing of 66982, is not related to the surgeon’s perception of the surgical difficulty,” says Part B payer Noridian Medicare in its local coverage determination, which was last updated in 2019. “The use of this code is governed by the need to employ devices or techniques not generally used in routine cataract surgery.”

Report 66982 only if a more complex procedure is necessary and the surgery meets the requirements of the code descriptor. Documentation in the medical record will support this decision.

Bolster your claim: Noridian points out that you should ideally have the physician send communication (such as a letter or an introductory paragraph with your op report) with your 66982 claims to justify medical necessity for the procedure. “Every complex cataract surgery must have a justification to meet the requirements of its CPT^® descriptor,” the payer notes. “Therefore, it is strongly recommended to include an initial supporting statement in the operative note.”

For instance, you might write something like, “Indication for Complex Cataract Surgery: Trypan blue dye was needed to adequately visualize the lens capsule in the presence of a mature cataract.”