Ophthalmology and Optometry Coding Alert

Question: How should I code the removal of a dislocated lens via a pars plana approach during which a minor posterior vitrectomy was performed to aid in the lens removal? Should I use 66852? We also inserted an intraocular lens.

Washington Subscriber

Answer: You have encountered one of the most difficult coding scenarios possible but if you keep in mind that your goal is to get paid for the work involved, no more no less, you can code this scenario with the help of a few modifiers.

Your first instinct may be to code 66852 (Removal of lens material; pars plana approach, with or without vitrectomy), but if you choose this code, you will not be reimbursed for the IOL insertion because 66852 does not include the insertion and there is no code strictly for an IOL insertion alone. Your second instinct might be to code 67036 (Vitrectomy, mechanical, pars plana approach) for the vitrectomy, but the minor posterior vitrectomy you described does not meet the work effort represented by 67036.

Two modifiers are required to correctly code your scenario: -52 (Reduced services) and -51 (Multiple procedures). One option is to code the vitrectomy 67036-52 to indicate that not all of the work represented in this code was provided. The vitrectomy has the higher fee, so it should be coded as the primary procedure. Next, code either 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis [one stage procedure]) or 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique), depending on the documentation, along with modifier -51. Modifier -51 will indicate to the payer that the procedure should receive the multiple-procedure reduction.