Ophthalmology and Optometry Coding Alert

Question: What code should I use to report when the ophthalmologist replaces an intraocular lens (IOL) because the incorrect power was inserted initially? Would it be 66984?

Tennessee Subscriber

Answer: You should use code 66986 (Exchange of intraocular lens) when an ophthalmologist is exchanging an existing intraocular lens.

Why: Code 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis, manual or mechanical technique) is not the correct code because in the situation you describe, the patient has already had the initial surgery and no longer has the cataract. The ophthalmologist is now removing the existing IOL and replacing it with a new one to achieve the correct power.

Caution: Don’t look for a code for the removal of the old lens and a separate code for the placement of the new lens. Payment for the removal and replacement are both included in 66986.

Alternative: 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).