Ophthalmology and Optometry Coding Alert

Question: The patient presents with a dislocated intraocular lens (IOL), which cannot be safely repositioned. The ophthal­mologist removes the dislocated IOL and inserts a new one. What CPT® code or codes should I report?

California Subscriber

Answer: CPT® code 66986 (Exchange of intraocular lens) describes the exchange of a previously implanted IOL. Payment for both the removal of the old lens and insertion of the new lens are included in 66986, so you should not code separately with 67121 (Removal of implanted material, posterior segment; intraocular) and 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal).

IOL exchange is usually performed in the case of an incorrect positioning of the placement of a lens of incorrect power – or, as in this scenario, the IOL has been dislocated and cannot be safely repositioned. If the ophthalmologist is inserting an IOL implant in a patient who had cataract surgery previously but did not have a lens implanted at the time of the previous surgery, you would report 66985.