Ophthalmology and Optometry Coding Alert
Clearing Up IOL Coding
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. 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.
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 your payer has the NCCI in place, it will include or bundle the 66850 as being mutually exclusive with 66985.
The lens was extracted and replaced with an intraocular lens. Should this be billed as 66999 and 66985-51?
Tennessee Subscriber
From the procedure you describe, you will need one of the following lens removal codes (depending on the method of removal):
If you removed the lens with phacofragmentation, the billing would be:
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.
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