Ophthalmology and Optometry Coding Alert

Question: What is the proper way to code intraocular lens (IOL) insertion at the same time as removal of lens material for dislocated lens?

Arkansas Subscriber

Answer: If the lens was slightly dislocated and there is only a small amount of vitreous clean-up necessary in the anterior chamber, code 66984 (extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique]) for an extracapsular cataract extraction and IOL insertion, or 66983 (intracapsular cataract extraction with insertion of intraocular lens prosthesis [one stage procedure]) for an intracapsular extraction with IOL along with 67010-59-51 (removal of vitreous, anterior approach [open sky technique or limbal incision]; subtotal removal with mechanical vitrectomy; -distinct procedural service; -multiple procedures) for the anterior chamber vitreous clean-up. Make sure that the anterior vitrectomy is described as mechanical and that some detail is provided of the extent of the work.

If the lens is seriously dislocated and a significant posterior vitrectomy is involved, select the cataract extraction code with IOL insertion (66983 or 66984) based on whether it was performed intracapsular or extracapsular along with 67036 for the posterior vitrectomy. Code 67036 (vitrectomy, mechanical, pars plana approach) should be used as the primary procedure, and either 66983 or 66984 should be coded secondary with the -51 modifier appended.

The most difficult scenario to code is when the lens is dislocated enough that it must be removed via a pars plana approach and a minor posterior vitrectomy is involved in getting the lens out. This scenario fits into the code description for 66852. Unfortunately that code does not include an IOL insertion. Since there is no code that describes a primary IOL insertion alone, and the posterior vitrectomy is not enough to claim the work effort included in 67036, it becomes a coding dilemma. Remember that the guiding principle in coding should be to seek payment for the work involved. Remember also that modifiers are available to indicate greater or lesser work than is reflected in the code used.

One prudent course would be to code either 66983 or 66984 along with 67036-52 (vitrectomy, mechanical, pars plana approach; -reduced services) to reflect that this case did not involve the work usually provided in a posterior vitrectomy. If this is done, it is also advisable to decrease your normal fee for 67036 to one that the surgeon indicates more accurately reflects the work involved. Because 67036 is the higher valued code, it will not receive the multiple procedure reduction in fee allowance and should not have the -51 modifier appended to it. Either 66983 or 66984 should have the -51 modifier appended to it and will receive the multiple procedure reduction.


Answers to You Be the Coder and Reader Questions were contributed by Raequell Duran, president of Practice Solutions, an ophthalmology coding and compliance company based in Santa Barbara, Calif.; Lise Roberts, vice president of Health Care Compliance Strategies, a consulting and compliance company based in Jericho, N.Y. ; and Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc., a coding and compliance company based in Spring Lake, N.J.