Wiki Ophthalmology Doubt

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Ravikirann

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Hi All,

I am new to Ophthalmology coding. Please help me out to choose CPT codes.

The patient is a 75-year-old male, who has noted progressive decreased vision in his left eye. After evaluation, he was found to have a white cortical type cataract as the partial cause of his 20/40 vision. After a complete discussion of the risks and benefits of the procedure was undertaken with the patient, he elected to have his cataract removed. He understands that his final vision will be limited by his other ocular conditions. He understands the complex nature of his surgery given his type. Intraocular dye will be used to better visualize it.


DESCRIPTION OF PROCEDURE: Topical anesthesia with 0.5% proparacaine was given in the preoperative area. This consisted of a 50:50 mixture of 2% lidocaine and 0.5% bupivacaine. A drop of Betadine was placed on the patient?s operative eye before he was brought to the operating suite. The patient?s operative eye was then prepped and draped in the usual sterile fashion for cataract surgery, including drops of Betadine on its surface.

A paracentesis tract was placed through which 1% non-preservative lidocaine was instilled. Vision blue dye was injected into the anterior chamber to better visualize the anterior capsule. It was irrigated from the chamber using balanced salt solution. Viscoat was used to fill the anterior chamber. A temporal clear corneal incision was made with a 2.8-mm keratome. A circular continuous capsulorrhexis was fashioned with a cystotome and Utrata forceps. Hydrodissection of the lens nucleus was performed, and this was phacoemulsified using a modified stop-and-chop technique. The remaining cortex was removed using automated irrigation and aspiration. The posterior capsule was then filled with Provisc and a foldable Alcon model SN60WF 19.0 diopter lens was placed without difficulty. The remaining viscoelastic was removed using the I&A tip. The anterior chamber was re-formed using balanced salt solution. The corneal wound was checked and found to be well sealed. Drops of Betadine and Zymar were placed over the operative eye as was a clear shield. The patient returned to the recovery area in stable condition.


Thanks
Ravi
 
You need to post what you think the codes would be. You can only learn when you come up with an answer and then if someone thinks there is a better choice they can indicate why.
 
It also sounds like you're describing two different encounters. One for the exam during which the diagnosis was made and the patient decided to have the surgery. The second is for the surgery itself.
 
I wouldn't say using the blue dye to visualize the anterior capsule makes the surgery complex. Using a good operating scope should make the capsule easily visible without having to use the dye.

I also agree with Mitchellde that the poster needs to try to come up with the appropriate codes versus asking others to code these encounters for them.
 
Hi sorry for not posting CPT code with OT notes. I coded 66984. Plz guide me. I taught it is extracapsular so i selected 66984.
 
Last edited:
66984 seems appropriate. I guess there's lots of debate as to whether the use of the dye alone makes it a complex so unless you want to spend a bunch of time trying to justify the circumstances are rare enough to qualify, I wouldn't waste my time. 66982 is supposed to be extremely rare under 3% of surgeries. If the physician commonly uses dye it would hard to argue exceptional circumstances

Here's an interesting article about deciding between complex vs regular

http://www.healio.com/ophthalmology...d-b6fc-1bfbc597fd69}/complex-cataract-surgery

Another article on the complex w/ dye controversy

http://www.rivaleeasbell.com/articles/cataractcontroversies.pdf
 
For any one else interested in this issue here is what I have found most recently - rather definitive - a 2016 AMA update to CPT Assist on the matter:

Here’s the article from CPT Assistant March 2016, page 10

Question: Does the use of Trypan Blue dye to stain dense cataract justify the use of a complicated cataract 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?

Answer: No, the additional work of instilling and removing Trypan Blue dye from the anterior segment though an additional surgical step does not reach the threshold of physician time, work, or intensity necessary to report the complex cataract code. Indications that justify reporting a complex cataract surgery (66982) includes:

1. 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.
2. 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.
3. Pediatric cataract surgery
 
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