Ophthalmology and Optometry Coding Alert

Question: Our billing manager wants to code 66982 every time she sees anything in the operative notes about complications such as vitreous prolapse or the need for sutures. Aren't we only supposed to use the complex cataract code when the ophthalmologist plans preoperatively that it will be a  complex procedure?

Illinois Subscriber

Answer: In most cases, an ophthalmologist performing 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) will be aware of the conditions that will make the cataract removal complex before he begins surgery, and thus will plan preoperatively to perform 66982.
 
However, sometimes the ophthalmologist cannot predict the need for "devices or techniques not generally used in routine cataract surgery" until the case has already begun.
For example, a pupil that seemed adequate at first may ultimately require stretching. If the ophthalmologist documents the reasons in the operative report, you may report 66982.
 
This code is often an audit target, since Medicare asserts that fewer than 4 percent of cataract operations involve enough work to meet the definition of complex cataract surgery.
 
There are, however, a few signs that will indicate to carriers the necessity of performing 66982:
   A miotic pupil that will not dilate sufficiently, requiring the ophthalmologist to use iris retractors and expansion devices, or perform a sector iridectomy or sphincterotomy
   A disease state weakening lens support structures, requiring permanent intraocular sutures or capsular support rings
   Pediatric surgery that is complicated by an anterior capsule that is difficult to tear, a cortex that is difficult to remove, and the need for a primary posterior capsulotomy or capsulorrhexis.