Wiki Trypan Blue Dye in Cataract Sx - help please

Create Wiki
C

centralizedcoding

Contributor
Messages
20
Location
Murfreesboro, TN
Best answers
0
Hey, there. So I will preface that I am a new coder. All the posts that I have seen are from 2017 or earlier regarding this. I've read many contradicting articles/posts as well.

When doctors state that they are using Trypan Blue Dye DUE TO poor red reflux in pt... Does this or does this not qualify as complex? I don't know if it "reaching" or "stretching", but trying to understand the medical standpoint sounds like this is required for better viewing to perform the surgery.

- I've had other doctors I've had to be in touch with mention it should be complex (not the providers I code for, others that I've spoken to regarding co-management issues).
- However, CMS LCD I find states that requirements for trypan blue to be complex is when it is in the setting of a mature cataract.
- I also called Palmetto and they couldn't give me any details regarding what kind of documentation they want for that (as in: does the op note need to specifically state "in the presence of a mature cataract" or something along those lines).

I'm just trying to be as thorough as possible in understanding if this IS or IS NOT enough to qualify as complex. Any help is appreciated. :)
 
Hello, I am not an expert. When our MDs are using trypan blue for just visualization, we don't code it as complex 66982. In a past, we were sending them queries asking them to document the obstacles, difficulties that necessitate the usage of this injection. It has to be some kind of complexity of the surgery. We found out that one of our MDs was using trypan blue just for his residents to better visualize the cataract; it's a simple 66984. Currently, our mds are documenting ' due to dense mature cataract." The key word is 'dense". The 'mature' i was told recently means that cataract is ready to be removed. So, i am focusing on 'dense mature' cataract for 66982.
 
I found some information on AAPC newsletters 2021:
4 Questions Point the Way to 66982

Ask yourself these questions when you’re deciding whether to report 66982:

  • Is the pupil miotic?
  • Is the patient very young, and still in the amblyogenic developmental stage?
  • Does the IOL need extra support, such as permanent intraocular sutures or capsular tension rings?
  • Does the ophthalmologist need to use dye to visualize the anterior chamber?
If the answers are “yes,” you may be able to report 66982 instead of the lower-reimbursing 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) for an extracapsular cataract removal. However, it’s still not guaranteed.

Payment for 66982, based on the 2021 Medicare Physician Fee Schedule, is about $750, compared to $548 for 66984. Therefore, correctly using this code could net your practice about 26 percent more income — but only if you use it correctly. Applying 66982 in the wrong way could set you up for audits and refund requests.
In black and white: “The billing of 66982, is not related to the surgeon’s perception of the surgical difficulty,” says Part B payer Noridian Medicare in its local coverage determination, which was last updated in 2019. “The use of this code is governed by the need to employ devices or techniques not generally used in routine cataract surgery.”

Report 66982 only if a more complex procedure is necessary and the surgery meets the requirements of the code descriptor. Documentation in the medical record will support this decision.

Bolster your claim: Noridian points out that you should ideally have the physician send communication (such as a letter or an introductory paragraph with your op report) with your 66982 claims to justify medical necessity for the procedure. “Every complex cataract surgery must have a justification to meet the requirements of its CPT® descriptor,” the payer notes. “Therefore, it is strongly recommended to include an initial supporting statement in the operative note.”

For instance, you might write something like, “Indication for Complex Cataract Surgery: Trypan blue dye was needed to adequately visualize the lens capsule in the presence of a mature cataract.”
 
Last edited:
I also found AAPC newsletter from 2014: ""Question: So what makes a cataract surgery “complex”?
  • Poor visualization: If the cataract is unusually dense — such as a hypermature cataract (ICD-9 code 366.18) or white cataract (366.17) — the ophthalmic surgeon may need to inject dye such as trypan blue to help him visualize the anterior chamber.
  • Question: What documentation do we need?

    Answer:     Complex cataract surgery should be planned preoperatively, experts say. The ophthalmic surgeon should know ahead of time if she will need to perform 66982, and should note it in the preoperative report. For example, she may note that the pupil looks miotic and may need to be expanded (noting the size of the pupil before and after manipulation), or that the patient suffers from hypermature cataract and will need dye for visualization. ""
 
and the last one from 2017 AAPC Newsletters:
"Other payers differ: Palmetto, on the other hand, includes different examples of allowable situations that allow for 66982, as follows (although Palmetto stresses that this list is not all-inclusive):

  • Insertion of iris retractors through additional incisions
  • Mechanical expansion of the pupil using hooks
  • Creation of a sector iridectomy with subsequent suture repair of iris sphincter
  • Use of a Malyugian ring and multiple iris sphincterotomies created with scissors.
  • The need to support the lens implant with permanent intraocular sutures
  • Placement of a capsular support ring necessary to allow secure placement of an intraocular lens
  • Performance of pediatric cataract surgery with intraocular lens insertion
  • Use of intraocular dyes (e.g. trypan blue or indocyanine green) to stain the lens capsule in the setting of a mature cataract.
If you do get a notification that your cataract records are being audited by one of the RACs, don’t panic. Gather your documentation and all supporting notes to be ready for the auditor — and if your documentation is thorough and complete, you’ll likely pass the audit with flying colors.

Resource: To read the audit issue detail on the RAC pages, visit http://www.cotiviti.com/healthcare/who-we-serve/cms-approved-issues and https://www.dcsrac.com/IssuesUnderReview.aspx.""
 
Thank you so much for all of the information! I will get with my providers regarding the wording. I really appreciate you mentioning that "dense mature" may be the best way to get this documented for those circumstances. It's very nice to hear from others to make sure I haven't missed anything. Thank you again! :)
 
You must log in or register to reply here.
Top