Ophthalmology and Optometry Coding Alert

Watch that you don’t confuse an IOL with a natural lens—or that could blur your code choices.

When a patient patient has a dislocated intraocular lens (IOL), you may have questions about how to report all the work involved in correcting the problem. Have a look at this op report for IOL removal we recently received from a subscriber and then review our expert coding advice as an illustration of how to bill these services.

Review the Report

Diagnosis: IOL dislocation

Procedure summary: Right eye IOL removal from anterior approach, IOL removal pars plana approach with limited pars plana vitrectomy

Details: A lid speculum was placed, and using the operating microscope, a 6.0mm peritomy was made superiorly. Using a crescent blade, a 6mm scleral tunnel corneal incision was made into the anterior chamber. Two paracentesis wounds were made at 5 and 9 o’clock. An anterior chamber maintainer was placed in the 5 o’clock paracentesis wound. Using lens scissors through the superior wound and serrated forceps through the temporal paracentesis wound, the lens was cut 80 percent across its middle and gently externalized through the main wound.

Once half of the IOL was cut all the way through and removed safely out of the eye, the second half of the IOL was removed from a pars plana approach. Two 25-gauge trocars were placed superotemporally and superonasally.

Using back flush, the IOL was aspirated anteriorly and explanted through the superior scleral incision. Scleral depression was performed to inspect the retina and no tears or holes were noted. A gentle limited core vitrectomy was performed.

Define ‘Implanted’ for Correct Coding

Based on the documentation provided in the report, you would use the following CPT^® codes for the physician’s intraocular lens (IOL) removal work.

First, for the lens removal using the anterior approach, report 65920 (Removal of implanted material, anterior segment of eye).

Then, for the pars plana removal approach with vitrectomy, report 67121 (Removal of implanted material, posterior segment; intraocular).

Rationale: You may be considering 66852 (Removal of lens material; pars plana approach, with or without vitrectomy) instead. But beware. This is a case where a keen eye for detail is needed to select the right code. Note that code 66852’s descriptor says “lens material,” whereas code 67121 indicates “implanted material.”

What this means: “Lens material” equals a “natural” lens, whereas “implanted material” is an IOL.

So, the reason 67121 is a more accurate choice than 66852 is because the patient already has an IOL in place and, therefore, the physician is not removing a “natural” lens, confirms Gina Vanderwall, OCS, CPC, CPPM, financial counselor with Finger Lakes Ophthalmology of Canandaigua, NY.

Just to point out: You may also be wondering why you wouldn’t also report CPT^® code 66930 (Removal of lens material; intracapsular, for dislocated lens).

The reason is because the clinical responsibility for this code indicates that the physician removed the “natural” lens along with the surrounding capsule, not the IOL that is in place, says Vanderwall,

In this case, the surgeon removed the second half of the IOL via pars plana approach, which means the correct code would be 67121.

Don’t Forget to Code Capture the Vitrectomy

Finally, you would report 67036 (Vitrectomy, mechanical, pars plana approach) for the vitrectomy, pars plana approach. This describes the physician’s removal of the vitreous fluid to access the posterior segment of the eye and introduce surgical instruments through incisions in the pars plana, the darkly pigmented posterior area of the ciliary body, the structure that lies just behind the iris.

Skip +69990: The operative report shows that the physician used an operating microscope. Don’t report add-on code +69990 (Microsurgical techniques, requiring use of operating microscope (List separately in addition to code for primary procedure)), however. The use of the operating microscope is included in the procedure code and is not billed separately, as is the case with many ophthalmologic surgeries, says Vanderwall.

Specify IOL Displacement with Dx

Be sure to include an ICD-10-CM code that indicates an IOL dislocation and not a natural lens dislocation, cautions Vanderwall.

For the dislocated IOL, choose a code from the T85.22X (Displacement of intraocular lens) group, depending on whether it’s an initial or subsequent encounter. Use T85.22XA (Displacement of intraocular lens, initial encounter) for an initial encounter or T85.22XD (Displacement of intraocular lens, subsequent encounter).