Ophthalmology and Optometry Coding Alert

Question: One of our physicians performed a pupilloplasty. What is the correct code for this procedure?

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Answer: To code pupilloplasty, you must first determine whether it was performed with or without a laser. Pupilloplasty is a procedure that enlarges pupil size by opening the visual axis. The procedure is performed when small pupils are unresponsive to pharmacological dilation for near-vision problems caused by small pupil size, acute angle closure glaucoma, or by post cataract treatment and presbyopic lens extraction.

Patients with acute primary-angle closure (PAC) have pain, have disturbed vision, and almost always have a higher intraocular pressure (IOP) than occurs with primary open-angle glaucoma. Usually done using an argon laser, pupilloplasty provides a noninvasive treatment for PAC. The laser is focused through the center of a three-mirror lens; the radial burns cause the pupil to enlarge as the iris tissue contracts. (In children having congenital cataracts or PHPV with scar tissue that closed the pupil until it's too small to be useful, and who cannot be still enough for a laser, surgery opens the scar tissue and iris to enlarge the visual axis.)

For a pupilloplasty done with a laser to improve vision, use 66762 (Iridoplasty by photocoagulation [1 or more sessions] [e.g., for improvement of vision, for widening of anterior chamber angle]). If glaucoma was the cause, and the procedure was done without a laser, use 66630 (Iridectomy, with corneoscleral or corneal section; sector for glaucoma [separate procedure]); if a laser was used, use 66761 (Iridotomy/iridectomy by laser surgery [e.g., for glaucoma] [per session]).