Ophthalmology and Optometry Coding Alert

Answer: The answer depends on whether the procedures — 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [1-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) and 67010 (Removal of vitreous, anterior approach [open sky technique or limbal incision]; subtotal removal with mechanical vitrectomy) — were performed on the same eye or different eyes, and whether the vitreous removal became necessary due to a complication of the surgery. 

 

If they were performed on the same eye, and the surgeon had to perform a vitrectomy due to a vitreous collapse during the cataract surgery, Medicare considers it part of the work involved in performing 66982; it is an iatrogenic, or inadvertently produced, complication. 

 

If, however, the ophthalmic surgeon knows about a pre-existing prolapsed vitreous (in other words, it is not an iatrogenic complication of the surgery) and notes in the preoperative report her plans to perform a vitrectomy, you can report 67005 (Removal of vitreous, anterior approach [open sky technique or limbal incision]; partial removal) or 67010 in addition to 66982.

In that case, the proper modifier to append to 67005 or 67010 would be 59 (Distinct procedural service), not 51 (Multiple procedures).

 

If the procedures were performed on two different eyes, you would report them separately with modifier 59 appended to 67005 or 67010, as well as the LT (Left side) or RT (Right side) modifiers.