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Ophthalmology and Optometry Coding Alert

You Be the Coder:

Partial Cataract Extraction

Published on Mon Jul 10, 2006

Question: We took a patient in for cataract surgery and IOL insertion, and ended up not finishing due to some complications. Before discontinuing, the ophthalmologist performed a partial cataract extraction and vitrectomy. What is the appropriate way to code for this? Should I use modifier 53?


Washington Subscriber


Answer: First, you need to know if the complication was related to the patient's well-being (e.g., tachycardia, cardiac arrest or unstable blood pressure), or if the complication was a surgical problem. If the ophthalmic surgeon could have completed the surgery but discontinued it due to the patient's well-being, then append modifier 53 (Discontinued procedure) to the cataract code--for example, 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis ...).

If the complication was a surgical issue (e.g., severe swelling with scar tissue, excessive bleeding) and the ophthalmic surgeon decided he could do no more during the current operative session, append modifier 52 (Reduced services) to the cataract removal code.

Correct coding dictates that if there is a code that describes the work the physician actually did, you should report that instead of a code that describes what he was planning to do, without any modifiers. In this case, you may be able to report 66852 (Removal of lens material; pars plana approach, with or without vitrectomy) for the work accomplished.

When the patient comes back for the IOL insertion, you can report 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal). If the global period for the first surgery code is still in effect, append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to 66985.

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