Ophthalmology and Optometry Coding Alert

Question: A patient is going to have a secondary IOL implant. Is 66985 the right code? What's the difference between 66985 and 66986?

Tennessee Subscriber

Answer: 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, report 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal). For example, if complications during the original cataract surgery prevented the surgeon from implanting the IOL at that time, he may need to perform 66985 later on.

You should also report 66985 if the ophthalmologist is inserting a piggyback IOL after a previous cataract surgery. But if the ophthalmologist inserts the piggyback IOL during cataract surgery, CPT directs you to 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis, manual or mechanical technique, complex, requiring devices or techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage), 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis) or 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis, manual or mechanical technique).

However: If the ophthalmologist is exchanging a previously implanted IOL, report 66986 (Exchange of intraocular lens). This procedure is rare, but it's necessary in some cases--for example, if the previous implant turns out to be the wrong power, or if the lens gets dislocated and the ophthalmologist can't reposition it safely. Do not report an additional code for removing the previous lens; it is included in 66986.