Ophthalmology and Optometry Coding Alert

Question: When coding for cataract surgery, is it required or optional to code Z98.4 for the cataract extraction? So far claims have been paid without it, but I wanted to know if it is more completely coded with it, and if there will be an issue down the road if it is not included on the claim.

Florida Subscriber

Answer: If you’re coding for the actual procedure, it wouldn’t be appropriate at all to code anything from the Z98.4- (Cataract extraction status) family. Those codes represent somebody who has a history of cataract surgery. If you had a patient who had had cataract surgery in the past, then came in post-op or later for a follow-up or a problem that may be affected by the prior surgery, then you would use a Z98.4- code. It’s analogous to V45.61 (Cataract extraction status) in ICD-9.

When you’re coding for the actual surgical procedure, you would probably want to use one of the cataract diagnosis codes from the H25 (Age-related cataract) or H26 (Other cataract) families.

Read more: You can read the full CMS article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/ SE1408.pdf.