Wiki Help understanding op report for lysis of iris-anterior capsule adhesion

Kelly_Josephine

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I coded the following report with 66840-LT & 65870-LT (H26.492, Z98.69, H21.512) but it was rejected - and I now find the physician scheduled 66840 with 67005.

66840 - Removal of lens material; aspiration technique, 1 or more stages
67005 - Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal
65870 - Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae


Can anyone help me understand which coding is correct and why?

POSTOPERATIVE DIAGNOSES:
1. Elschnig pearls (lens material) left eye.
2. Iris-anterior capsule adhesion, left eye.

PROCEDURES:
1. Removal of Elschnig pearls, left eye.
2. Lysis of iris-anterior capsule adhesion, left eye.

...A lid speculum was used to provide adequate exposure. Superior and inferior paracentesis sites were created with a side port blade. Lidocaine MPF was then injected to facilitate intracameral anesthesia. Bimanual irrigation and aspiration was then introduced and the Elschnig pearls aspirated very nicely. Then under irrigation, the side port blade was used to lyse the adhesion between the iris and the anterior capsule at 12 o'clock. Balanced salt solution was then used to hydrate the wounds until they were watertight. At the end of the case the anterior chamber was noted to be deep. The intraocular pressure was physiologic and the intraocular lens that was existing remained in good position. The lid speculum and drapes were carefully removed...
 
The only thing I can see is the Z-Code, which my ICD-10 book doesn't show. Other than that, I'm inclined to go with the codes you selected initially, rather than the codes the physician chose, based on the op-report presented.

Hope this helps,

David E. Keown, CPC, OCS

The Z code was a typo that I did not catch when posting here - good catch

This is at least the second time you have stepped in to help me out David - I am very grateful. Thank you so very much!
 
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