Wiki Lensectomy for Narrow Angles ?

[arparkins]

Patient has had an LPI with no help of lowering pressure, so was scheduled for a Lensectomy or removal of lens material. I do not know if that diagnosis will even be covered under this procedure. The main problem is not only did the doctor remove the natural lens, but he also replaced it with a standard IOL. It can not be coded as a 66984 as there were no cataracts. An IOL exchange 66986 can not be used due to that code being for the exchange of an old prosthetic for a new one. Do I code a removal 66850 along with an insertion 66985?? If so, will narrow angles be covered for these procedures? Any help or suggestions are greatly appreciated!
Thanks,
April Parkins

 

[gamos]

LPI/lensectomy not done to lower IOP

Dear April,

a LPI is a prophylactic procedure to prevent acute narrow angle glaucoma attacks. These are usually performed on pts with moderate to high amts of hyperopia as their lenses tend to be more convex, pushing the iris forward and crowding the angle.

LPIs are not done to lower IOP.

There is some evidence that the IOP may be lowered by 2-3 mmHg following a cataract surgery (with PC IOL implant). The reason is that after removing the natural crystalline lens, the iris tends to fall back from the angle thus slightly changing the anatomy in the opposite direction as with a hyperope.

No ophthalmologists that I know would perform either a LPI or cat extraction for the specific purpose of lowering IOP. Neither is considered standard of care.

The surgery of choice would likely be a SLT to lower IOP if pt was non-adherent with gtts or adherent with drops, but not getting a good response.

I know that doesn't help with your coding question, but the case just doesn't make sense.

gamos@salus.edu