Wiki Unplanned Vitrectomy during Complex Cataract surgery

[TnRushFan]

Hello all,
We are having a discussion in our office about the unplanned vitrectomy due to posterior tear/vitreous prolapse during complex cataract surgery. Some in our office want to code the vitrectomy with -XU, referencing guidance for a planned vitrectomy and some think it bundles into the cataract since was unplanned.

Operative Events: posterior capsular tear requiring anterior vitectomy and placement of sulcus 3-piece lens
** apparent there was a posterior capsular tear, previously obscured by epinucleus
** small strand of prolapsed vitreous was present at the temporal incision… was cut
** inferior paracentesis incision was created… presence of some vitreous at the temporal incision
** anterior vitectomy was initiated
** anterior chamber and angle were swept to clear vitreous
** remove vitreous from a posterior location
** lens on a B-cartridge was injected into the ciliary sulcus
** miotic pupil remained circular with no evidence of vitreous prolapse

Thank you for all thoughts.

 

[Edmundo]

Hi @TnRushFan

It’s a pleasure!
CPT 67010 may be reported separately with modifier -59 only when the anterior vitrectomy is:

• Pre-planned and medically necessary for a separate indication
• Unrelated to the routine cataract surgery
• Clearly documented with separate intent, indication, and anatomical service

Example of separately reportable scenario:
“Planned anterior vitrectomy performed to treat pre-existing vitreous prolapse identified prior to cataract surgery. No intraoperative complication occurred.”

If an anterior vitrectomy is performed intraoperatively due to a posterior capsule rupture and vitreous prolapse—both recognized complications of cataract surgery—it is considered part of the cataract procedure. Since the vitrectomy is performed to manage the complication and support intraocular lens (IOL) placement, it is bundled into CPT 66984 and not separately reportable under CPT and NCCI guidelines. In such cases, modifiers -59 or -XU would not apply, as the service is not distinct from the cataract surgery.

Best,

Edmundo Gonzalez, CPC, CRCR, COPC, OCS
Sr. Coding Analyst

 

[natashalage]

Hello to all, i just found AAPC newsletter from July on your topic.

Can You Report 67010 Separately From Cataract Surgery?​

Published on Fri Jul 25, 2025

PDF


Question: I have an op note for a complex cataract surgery where the surgeon performed an unplanned vitrectomy due to a posterior tear/vitreous prolapse. Below are highlights from the note:

Posterior capsular tear requiring anterior vitrectomy and placement of sulcus 3-piece lens. Apparent there was a posterior capsular tear, previously obscured by epinucleus. Small strand of prolapsed vitreous was present at the temporal incision … was cut. Inferior paracentesis incision was created… presence of some vitreous at the temporal incision. Anterior vitectomy was initiated. Anterior chamber and angle were swept to clear vitreous. Remove vitreous from a posterior location. Lens on a B-cartridge was injected into the ciliary sulcus. Miotic pupil remained circular with no evidence of vitreous prolapse.

How should we report the unplanned vitrectomy procedure?

Tennessee Subscriber
Answer: When the surgeon performs the anterior vitrectomy during the cataract surgery because of the posterior capsule rupture and vitreous prolapse, the vitrectomy is considered part of the cataract procedure. The capsule rupture and vitreous prolapse are recognized complications of cataract surgery. The vitrectomy is performed to manage the complication and support intraocular lens (IOL) placement; therefore, you’ll report 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) to report the complex cataract surgery.

On the other hand, you can report 67010 (Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal with mechanical vitrectomy) separately with modifier 59 (Distinct procedural service) when the anterior vitrectomy is preplanned and medically necessary, unrelated to the cataract surgery, and the documentation shows the intent, indication, and anatomical service