Complex? Cataract extraction w/ intracameral epinephrine floppy iris - 66984 vs 66982

Kelly_Josephine

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I can not find anything anywhere to support the use of 66982 with this procedure. Please advise if anyone has information to show that this qualifies as complex...

The dx is right, but the epinephrine enable the surgeon to avoid use of other device... so 66984 only?

I am coding for ASC. Thanks in advance!

POSTOPERATIVE DIAGNOSIS: Visually significant nuclear sclerotic and posterior subcapsular cataract. right eye.
PROCEDURE: Cataract extraction by phacoemulsification with placement of intraocular lens, right eye, requiring intracameral epinephrine

...A lid speculum was used to provide adequate exposure. A superior paracentesis site was created with a sideport blade. Lidocaine MPF was then injec ted to facilitate intracameral anesthesia. Due to a history of Flomax use and borderline pupil dilation. Intracameral epinephrine was introduced to maximize dilation as well as prophylax against floppy iris syndrome. Viscoat was then injected to fill the anterior chamber. The clear corneal main incision was then created with a 2.4 mm keratome blade temporally The cystitome and Utrata forceps were used to create a continuous curvilinear capsulorrhex 1s . Balanced salt solution through a hydrodissection cannula was used to perform gentle hydrodissection and hydrodelineation and the lens was noted to rotate freely_ Phacoemulsification was then used to remove the nuclear and epinuclear material. Irrigation and aspiration were used to remove any remaining cortical material. Provisc was injected to fill the capsular bag_ The above mentioned intraocular lens was injected into the capsular bag and rotated into proper position using a Sinskey hook. Irrigation and aspiration were used to remove any remaining viscoelastic material. Balanced salt solution was used to hydrate the wounds until they were water-tight...
 

Kelly_Josephine

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Anybody?

Does any one have any thoughts on wether or not the epinephrine injection impacts the coding? It seems much like the use of Trypan Blue and I am worried that I am missing a valid reimbursement opportunity.
 

dkeown

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Complex?

Does any one have any thoughts on wether or not the epinephrine injection impacts the coding? It seems much like the use of Trypan Blue and I am worried that I am missing a valid reimbursement opportunity.

According to the information provided by JCAPHO/AAOE in their Cataract-Anterior coding module:

The following situations do not qualify for complex cataract surgery:
• Complications that occur during surgery
• Vitrectomy performed at the time of surgery
• Piggy-back or multifocal IOL
• Use of a specific viscoelastic like Healon 5 or Healon GV
• Really tough cases that take longer
• Because you did something not usually performed in routine cataract surgery
• Shugarcaine intraoperatively
• Monovision
• Premium IOLs
• Pharmacologic pupil dilation
• Floppy iris syndrome — unless one of the criteria listed below is met
Indications:
• A miotic pupil that will not dilate sufficiently to allow operative access to the lens and that requires the insertion of one of the following:
–– Four iris retractors through four additional incisions
–– Beehler expansion device
–– A sector iridectomy with subsequent suture repair of iris sphincter
–– Or sphincterotomies created with scissors.

Based on your Op note, I don't believe the criteria is met to code 66982 (pharmacological dilatation vs extra instrumentation.)

David Keown, CPC
 
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