Ophthalmology and Optometry Coding Alert

AdminaStar Federal, the Medicare Part B carrier for Indiana and Kentucky, has issued a local medical review policy (LMRP) for cataract extraction that includes the unusual step of listing separate diagnosis codes that must be used in addition to one from the primary diagnosis code list to bill 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). The code descriptor is weighted with technique, and AdminaStar has devised a way to work that technique into the medical-necessity list. The primary diagnosis codes in AdminaStar's cataract LMRP include the following: 361.xx Retinal detachments and defects 362.xx Other retinal disorders 364.23 Certain types of iridocyclitis; lens-induced iridocyclitis 365.51 Glaucoma; glaucoma associated with disorders of the lens; phacolytic glaucoma 366.xx Cataract 367.xx Disorders of refraction and accommodation 379.xx Other disorders of eye. All cataract procedure codes must be accompanied by one of the designated diagnosis codes in the primary list. Also, there's a secondary list for 66982. In this special medical-necessity listing, AdminaStar requires that in addition to one of the primary diagnoses, you must use one of the secondary diagnoses as well.

The secondary code list includes 364.51 (Disorders of iris and ciliary body; degenerations of iris and ciliary body; essential or progressive iris atrophy), 364.55 ( miotic cysts of pupillary margin), 364.57 ( degenerative changes of ciliary body), 364.59 ( other iris atrophy), 364.75 ( adhesions and disruptions of iris and ciliary body; pupillary abnormalities), 364.76 ( irido-dialysis), 364.8 ( other disorders of iris and ciliary body), 364.9 ( unspecified disorder of iris and ciliary body), 379.32 (Other disorders of eye; aphakia and other disorders of lens; subluxation of lens), 379.33 ( anterior dislocation of lens), 379.34 ( posterior dislocation of lens), 379.40 ( anomalies of pupillary function; abnormal pupillary function, unspecified), 379.41 ( ani-socoria), 379.42 (Miosis [persistent], not due to miotics), 379.43 (Mydriasis [persistent], not due to mydriatics), 379.45 ( Argyll Robertson pupil, atypical), 379.46 ( tonic pupillary reaction), 379.49 ( other), 743.36 (Congenital anomalies of eye; congenital cataract and lens anomalies; anomalies of lens shape), 743.37 ( congenital ectopic lens), 743.45 ( coloboma and other anomalies of anterior segment; aniridia) and 743.46 ( coloboma and other anomalies of anterior segment; other specified anomalies of iris and ciliary body).

AdminaStar also tells you when you should report certain diagnoses to support 66982. The carrier gives coders an idea how to select a code based on documentation and informs ophthalmologists how to document to [...]