Use of CTR with Trulign Lens


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Hello! We have a doctor that is using a Capsular Tension Ring when he inserts a Trulign lens during cataract surgery. Use of a CTR usually denotes a complex cataract; however, I'm hesitant to bill it as a complex because there is no indication of the surgery being complex. He only inserts the CTR because of this specific lens. Any thoughts on this is greatly appreciated. Here is a copy of the operative report:

The operating microscope was brought into place and used throughout the entire case. The lid speculum was placed into the eye. A side port incision was made in the cornea. Then, 0.3 mL of 1% nonpreserved Xylocaine was injected into the anterior chamber. Viscoelastic was injected into the anterior chamber. A 2.8 mm incision was made in the cornea at 15 degrees. The Utrata forceps were inserted, and an incision was made in the capsule and this was continued in a continuous curvilinear capsulorrhexis. Hydrodissection was performed and a good fluid wave was noted. The lens was flipped using the phaco-flip technique. The phaco handpiece was inserted and the lens was emulsified. The I/A tip was inserted and the remaining cortical remnants were removed. The viscoelastic was reinserted into the eye. The bag was inspected and there were no tears or rents. The ORA was then aligned and a measurement was taken. The lens power was adjusted accordingly. A capsular tension ring was inserted. The intraocular lens was then injected into the capsular bag. The ORA was then used again to align the lens to the correct axis as necessary. The I/A tip was reinserted into the eye and the remaining viscoelastic was removed. Lens centration was confirmed. BSS was used to reinflate the eye. All incisions were hydrated using BSS and the corneal seal was confirmed. Estimated blood loss was negligible. Complications: None.

Thank you in advance!


Maricopa, AZ
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Hi Stacey,

Based off what you have provided, your code should be a standard cataract. Complex cataracts are usually mycotic pupils, pediatrics with more complicated cases, blue-dye, etc. Anytime there is a need to code complex Cat surgeries, there should be documentation supporting the reason behind the complexity. I hope this helps!


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Since this is a specialty IOL, for which the patient has most likely been charged an additional amount, above and beyond what CMS allows for a standard IOL, I assume that the surgeon is using the CTR to be sure the IOL is aligned properly for best vision.

I would not bill this as a complex cataract surgery.

Tom Cheezum, O.D.,CPC