Ophthalmology and Optometry Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Our physician removed a dislocated (natural) lens, and placed an intraocular lens (IOL). What codes should we use? New Mexico Subscriber Answer: If the procedures are performed in two sessions, report 66930 (Removal of lens material; intracapsular, for dislocated lens) for the day the dislocated lens is removed, and 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) with modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) appended for the day the IOL is placed. If the procedure meets one of the criteria for a complicated cataract extraction, report 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one step 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). If the procedure is not a complicated extraction and is performed in a single session, for an intracapsular removal you should report 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis [one stage procedure]), or for an extracapsular removal assign 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).

Intracapsular means the lens and capsule (anterior and posterior) are removed. In the case of a dislocated lens, this is often what occurs. Extracapsular means the anterior capsule and lens are removed, but the posterior capsule is left in place to hold the IOL. Dislocations often disrupt the posterior capsule enough that it cannot be left in place.