Ophthalmology and Optometry Coding Alert

Confusion persists regarding 66982, the new code for complicated cataract surgery. Some ophthalmologists want to use the code, which reimburses almost $1,000, for any cataract surgery they deem to be complicated. But if they follow their own coding philosophy, and not official rules, they risk charges of abusive and possibly even fraudulent billing. They also put the codes future in jeopardy. HCFA may eliminate coverage for the code if ophthalmologists misuse it.

CPT says to use 66982 for cataract surgery that requires devices or techniques not generally used in routine cataract surgery, and goes on to give examples. But a groundswell of opinion among many ophthalmologists and coders holds that the examples in CPT are just that: examples.

The descriptor for 66982 says e.g. (for example), not i.e. (that is) before giving the examples. Therefore, many ophthalmologists believe they can use the high-paying code for more than the examples given, which are:

1. iris expansion device;
2. suture support for intraocular lens;
3. endocapsular rings; or
4. primary posterior capsulorrhexis.

Not for Vitrectomies

Ophthalmologists have many other examples of what they consider to be complicated cataract surgery. Ophthalmologists must sometimes perform anterior vitrectomies (67005-67010) as a part of cataract surgery to remove vitreous from the anterior chamber when, for example, the cataract is very dense, causing vitreous loss during the surgery. The ophthalmologist performs the vitrectomy to manage a complication of the cataract surgery.

The CPT descriptor for 66982 does not mention or prohibit its use for a complication, says Michael Yaros, MD, a solo practitioner in Runnemede, N.J. The CPT descriptor likewise doesnt limit the use to the scenarios listed. But you should never use 66982 for cataract surgery performed with an anterior vitrectomy. Most of the time, you should not even bill a regular cataract code with an anterior vitrectomy.

Codes 67005 and 67010 are listed as components of 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]) on the Correct Coding Initiative (CCI) and are not separately payable for iatrogenic complications. The billing of 66984 and 67005 or 67010 with modifier -59 (distinct procedural service) would be unbundling, a type of Medicare billing fraud, says Raequell Duran, president of Practice Solutions, a Santa Barbara, Calif.-based ophthalmology coding and compliance consultancy.

Nine out of 10 times, the need for anterior vitrectomy is an iatrogenic complication of the cataract surgery, says Lise Roberts, vice president of Health Care Compliance Strategies, an interactive compliance [...]