Ophthalmology and Optometry Coding Alert

Question: We have a patient who has Myopia that could not be corrected with glasses, and he could no longer wear contacts due to corneal erosion.
 
The lens was extracted and replaced with an intraocular lens. Should this be billed as 66999 and 66985-51?
      
Tennessee Subscriber Answer: The answer to your question depends on what type of insurance the patient has and whether the payer uses the National Correct Coding Initiative (NCCI) to process claims.
 
From the procedure you describe, you will need one of the following lens removal codes (depending on the method of removal):    66840 - Removal of lens material; aspiration technique, one or more stages
   66850 - ... phacofragmentation technique (mechanical or ultrasonic) (e.g., phacoemulsification), wit aspiration
   66852 - ... pars plana approach, with or without vitrectomy
   66915 has been deleted
   66920 - ... intracapsular
   66985 - Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal. You cannot use 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 [e.g., irrigation and aspiration or phacoemulsification]), because the code descriptions are for removal of cataract, which the patient does not have.
 
If you removed the lens with phacofragmentation, the billing would be:

   66850 + eye modifier (-RT, Right side; or -LT,  Left side), and
   66985-51 (Multiple procedure) + eye modifier    (-RT or -LT) If your payer has the NCCI in place, it will include or bundle the 66850 as being mutually exclusive with 66985. 
 
As a mutually exclusive bundle, you will need to determine which procedure payers will reimburse at a higher rate and only bill that (one) service.