Ophthalmology and Optometry Coding Alert

Question: We have a patient who underwent both 66682 and 66982. The insurance company is denying 66682, saying it is incidental to 66982. I've checked the Correct Coding Initiative (CCI) edits, and the two codes are not bundled. What can I do?

New York Subscriber

Answer: The insurance company's position may be that the work described 66682 (Suture of iris, ciliary body [separate procedure] with retrieval of suture through small incision [e.g., McCannel suture]) is sometimes necessary for complex cataract surgery (66982, Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex, requiring devices or techniques not generally used in routine cataract surgery [e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis] or performed on patients in the amblyogenic developmental stage).

Because ophthalmic surgeons sometimes use iris sutures in complex cataract removals, the carrier may see 66682 as included in 66982, even though there's no official CCI bundle.

Do this: Send in documentation (an operative note, for example) that clearly shows that 66682 was definitely distinct from the medical services the ophthalmic surgeon rendered in 66982, and that the iris suture was medically necessary on its own.

To separately report 66682 , the iris suturing must be separate and distinct, and unrelated to the complex cataract surgery.