Outpatient Facility Coding Alert

Question: Can I report complicated cataract code 66982 if the surgeon uses trypan blue to stain the cataract during extraction?

Delaware Subscriber

Answer: The use and removal of trypan blue does require more work and involvement on the part of the physician, however, it’s not enough to justify reporting code 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage).

According to CPT^® Assistant (March 2016; Volume 26: Issue 3), “the additional work of instilling and removing trypan blue dye from the anterior segment through an additional surgical step does not reach the threshold of physician time, work, or intensity necessary to report the complex cataract code.” More specifically, CPT^® Assistant lays out the following indications that do warrant the use of code 66982:

• “The presence of a miotic pupil that will not dilate sufficiently to allow operative access to the lens, which requires the insertion of one of the following: four iris retractors through four additional incisions; a Beehler expansion device; a sector iridectomy with subsequent suture repair of; an iris sphincter; or sphincterotomies created with scissors.
• “The presence of a disease state that produces »lens support structures that are abnormally weak or absent, which requires the need to support the lens implant with permanent intraocular sutures, or, alternately, a capsular tension ring may be necessary to allow placement of an intraocular lens.
• “Pediatric cataract surgery.”

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