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Ophthalmology and Optometry Coding Alert

Dont Confuse New Lens Insertions With Exchanges

Published on Tue Jul 01, 2003

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Clarify Intraocular Lens Implantation Coding


Coding intraocular lens (IOL) implantations and exchanges is not as straightforward as it seems our tricks of the trade will help you navigate your way to clean claims.
 
Ophthalmologists most commonly perform intraocular lens implants as part of cataract surgery, says Rita Knapp, CPC, of Indianapolis. In this procedure, the eye surgeon removes the cataract from the eye and replaces it with an artificial lens (the implant). You'll apply one of the following codes for these implants:

 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-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 (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage

 66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one-stage procedure)

 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification).

Lens Insertion Coding Tips From the Experts

Note the differences among these codes by carefully reading the detailed code descriptions, says Chris Felthauser, CPC, office manager at Maple Grove Eye Clinic in Idaho. You must use 66982 for complex cataract surgery with certain requirements. It must involve techniques not generally used, such as an iris expansion device; it cannot involve a complication during surgery and must be planned ahead of time. If a complication does arise, he adds, use the regular cataract surgical code, such as 66984, and append modifier -22 (Unusual procedural services) for the complication. Also, document the procedure by sending the carrier a note along with the operative report explaining why the procedure was a greater or unusual service.
 
Use 66982 for those cases in which difficulty is anticipated" poor outcomes are expected and higher risk is anticipated. The intent is that it should not be used in those instances when complications are incurred intraoperatively" says Riva Lee Asbell an ophthalmic reimbursement consultant in Philadelphia. "It is the intent that 66982 be used only when the physician plans prospectively and documents in the preoperative plan that a complex cataract procedure is to be performed."
 
Code 66982 covers cataract cases for patients with prior eye disease and cases that require extraordinary technique and instruments. "It's important to use this code when appropriate because reimbursement for it (about $845) is higher than for CPT code 66984 " says Lolita M. Jones RHIA CCS of Fort Washington Md in the July 15 2002 Review of Ophthalmology. She reinforces the fact that you should use this code when the ophthalmologist uses a special device such as "suture support for the IOL or primary capsulorrhexis occurs or the patient is in an amblyogenic developmental stage (decreased vision in one or both eyes without detectable anatomic damage to eye)."
 
Jones also emphasizes that documentation is a "very important issue" with 66982. Some coders feel they just don't have sufficient documentation to send anything and others attempt using the code without documentation. "Noting 'complex' in the chart is insufficient documentation " Jones says. "The doctor must document the specific aspect or aspects that meet code criteria such as extraordinary device used. With this in the chart auditors will not question the use of CPT code 66982."
 
Note that the expected percentage of patients who would require complex cataract surgery is about 2 percent of all cataract surgeries performed says Raequell Duran president of Practice Solutions in Santa Barbara Calif.
 
When inserting an intraocular lens that is not performed with cataract surgery use 66985 (Insertion of intraocular lens prosthesis [secondary implant] not associated with concurrent cataract removal). For example use this code for a patient who has had cataract surgery several years ago and is now ready for the implant Knapp says. However don't use this code for lens exchanges she adds (see the next section for more details).
 
Exercise caution with your carriers because they frequently confuse lens implantation with vision correction procedures Felthauser says. He recommends getting the procedure preauthorized to avoid confusion.

Comfortably Navigate Codes for Lens Exchange

Exchanging a lens although not a common procedure has its own code Knapp says. Use 66986 (Exchange of intraocular lens). Don't apply an additional code for removal of the previous lens because it's included in the exchange.
 
Be sure you document when the original lens was removed Felthauser says; this helps clarify the procedure for Medicare. He also suggests obtaining preauthorization.
 
Do not bill for the lens he says. The lens is bundled into the facility fee so code for the surgery (66982 66983 66984) and append modifier -SG (Ambulatory surgical center [ASG] facility service).
 
Note: When an ophthalmologist removes a lens at one operative session and places another lens at a different operative session this is not considered an exchange so you would bill the two services Duran says.

Don't Overlook  65920 67121 and 66682

For lens implantations and exchanges you may also need to use additional codes. When removing an intraocular lens from the anterior segment of the eye use 65920 (Removal of implanted material anterior segment of eye). If the lens dropped posteriorly into the vitreous and is removed in conjunction with a pars plana vitrectomy use 67121 (Removal of implanted material posterior segment; intraocular).
 
The CPT manual states that you can secondarily code suture fixation of a secondary intraocular lens implant with 66682 (Suture of iris ciliary body [separate procedure] with retrieval of suture through small incision [e.g. McCannel suture]).

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