Clarify Your Cataract Extraction Coding Knowledge — Part 1
Understand reporting of simple, complex, and combined procedures. With age comes wisdom, experience, and for more than half the population, visual disruptions in the form of cataracts. A cataract is a clouding of the natural lens of the eye, resulting in hazy, blurry vision. The condition usually develops over time, until the cataract interferes with activities of daily living (ADLs) such as reading, driving, watching television, or fine craft hobbies. Study These Cataracts Statistics According to the Centers for Disease Control and Prevention (CDC), cataracts affected more than 20 million Americans over the age of 40 in 2024, with that number expected to rise in the coming years. Six million more patients have had their cataracts surgically removed and replaced with an intraocular lens (IOL), which is an artificial lens intended to function the same as a natural lens. Roughly three million Americans have cataract surgery every year, making it one of the most commonly performed surgeries in the United States. Because of the volume of surgeries performed, the Centers for Medicare & Medicaid Services (CMS) and other payers periodically review or audit cataract CPT® codes. Coding for cataract extraction and IOL insertion can be straightforward, but it is important to code accurately with detailed, complete, and compliant documentation. Master the Basic Procedure Codes A standard cataract procedure involves breaking and removing the natural lens of the eye. The surgeon creates a paracentesis, or small puncture, and splits apart the lens either manually or, more commonly, by phacoemulsification, which is a probe that emits ultrasound waves to break up the lens and aspirate the fragments. An artificial lens is then placed into the capsular bag. CPT® code 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation) identifies a basic cataract extraction and IOL placement, without any bells and whistles. Conditions such as miosis (small pupils) or floppy iris (an intraoperative complication wherein a weak iris shifts out of normal position) may require additional measures for a successful outcome. These measures include, but are not limited to, iris hooks to aid in securing a floppy iris, or an iris expansion device for mechanical enlargement of the pupil. When correctly documented with medical necessity, these extra measures make a cataract surgery complex, which is coded with 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; without endoscopic cyclophotocoagulation). Know When to Report Combined Cataract and Glaucoma Treatments An estimated four million Americans suffer from glaucoma, a group of diseases characterized by unstable or increasing intraocular pressure, possibly leading to optic nerve damage. Cataracts and glaucoma may coexist, and patients affected by both conditions are often able to receive treatment for both at the same time. One or more anterior segment aqueous drainage devices, or stents, may be placed concurrent with cataract extraction. These stents aid in the outflow of aqueous fluid to help reduce intraocular pressure (IOP). In January 2022, new CPT® codes became effective that capture both components of this combination procedure. Code 66991 (… with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more) indicates standard cataract surgery along with placement of stent(s). If additional measures are required, look to 66989 (… with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more) for complex cataract surgery with placement of stent(s). Alternatively, the provider may use endoscopic cyclophotocoagulation (ECP) for partial destruction of the ciliary body to reduce fluid production, thus easing IOP. This laser treatment may be performed coincidental to cataract removal and would be billed as a combination surgery. CPT® code 66988 (… with endoscopic cyclophotocoagulation) indicates standard cataract extraction with ECP, while 66987 (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; with endoscopic cyclophotocoagulation) represents complex cataract surgery combined with ECP. Next month, Revenue Cycle Insider will examine the types of intraocular lenses (IOLs), various surgeries beyond traditional extraction and replacement of the lens, and additional procedures that could be required after surgery. Christine Killeen, CPC, CPB, COPC, Contributing Writer
