Ophthalmology and Optometry Coding Alert

Question:  Which CPT^® code do I use for the removal of a nuclear eye chip from the patient’s eye? The chip was pushed up from the iris and was found circulating around. The nuclear chip, which appeared to be about 0.4 mm after viewing on the slit lamp, was not an implanted material. The surgeon found it while doing cataract surgery and it resulted from phacoemulsification.

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Answer: If the eye care physician removes the nuclear chip during the same session as the cataract surgery, the removal would be considered an integral part of the primary procedure.

Here’s how this happens: During the phacoemulsification procedure, the eye care physician may use an ultrasonic device to break up the cloudy lens and then will use irrigation and aspiration (I&A) to remove it from the eye. During this surgery, the small fragments of the nucleus can end up in out-of-the way places. If the chip ends up elsewhere in the eye, the physician may discover and remove it during the surgery, often using the I&A procedure.

In some cases, the ophthalmologist may document a significant amount of extra work during the cataract excision due to his work extracting the nuclear chip. In these situations, it’s the physician’s call whether to append modifier 22 (Increased Procedural Services) to the corresponding cataract excision code.