Dont Confuse New Lens Insertions With Exchanges

Coding intraocular lens (IOL) implantations and exchanges is not as straightforward as it seems our tricks of the trade will help you navigate your way to clean claims.

Ophthalmologists most commonly perform intraocular lens implants as part of cataract surgery, says Rita Knapp, CPC, of Indianapolis. In this procedure, the eye surgeon removes the cataract from the eye and replaces it with an artificial lens (the implant). You'll apply one of the following codes for these implants:

• 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure) manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage

• 66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one-stage procedure)

• 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification).

Note the differences among these codes by carefully reading the detailed code descriptions, says Chris Felthauser, CPC, office manager at Maple Grove Eye Clinic in Idaho. You must use 66982 for complex cataract surgery with certain requirements. It must involve techniques not generally used, such as an iris expansion device; it cannot involve a complication during surgery and must be planned ahead of time. If a complication does arise, he adds, use the regular cataract surgical code, such as 66984, and append modifier -22 (Unusual procedural services) for the complication. Also, document the procedure by sending the carrier a note along with the operative report explaining why the procedure was a greater or unusual service.

Use 66982 for those cases in which difficulty is anticipated" poor outcomes are expected and higher risk is anticipated. The intent is that it should not be used in those instances when complications are incurred intraoperatively" says Riva Lee Asbell an ophthalmic reimbursement consultant in Philadelphia. "It is the intent that 66982 be used only when the physician plans prospectively and documents in the preoperative plan that a complex cataract procedure is to be performed."

Code 66982 covers cataract cases for patients with prior eye disease and cases that require extraordinary technique and instruments. "It's important to use this code when appropriate because reimbursement for it (about $845) is higher than for CPT code 66984 " says Lolita M. Jones RHIA CCS of Fort Washington Md in the July 15 2002 Review of Ophthalmology. She reinforces the fact that you should use this code when the ophthalmologist uses a special device such as "suture support for the IOL or primary capsulorrhexis occurs or the patient is in an amblyogenic developmental stage (decreased vision in one or both eyes without detectable anatomic damage to eye)." …….

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