Not only does a vitrectomy (67005, 67010) not qualify a cataract surgery as complex (either planned or unplanned) it is bundled under the CCI edits. Adding a -59 and billing for the vitrectomy in addition to the cataract surgery is a red flag under the CCI edits. You can only bill for the cataract surgery 66984. Sorry
Complex cataracts have a few rules depending on your Medicare's LCD but here are some general guidelines.
66982 cannot be used for complications during surgery.
66982 cannot be used for really tough cases that take longer.
66982 cannot be used for vitrectomy (unplanned or planned) at the time of surgery.
66982 cannot be used for piggy-back IOLs.
66982 cannot be used for routine dye staining of the capsule of nonhypermature cataracts.
66982 cannot be used for patients that were on Flomax therapy without needing rings, hooks or pupil stretchers.
66982 cannot be used for utilizing Healon5 or GV viscoelastics and manually manipulating the pupil.
66982 cannot be used for traumatic cataract extraction, requiring planned intracapsular ring, without lens implant.
66982 cannot necessarily for floppy iris syndrome, unless rings, hooks or pupil stretchers are used, not by adjusting the machine flow rates, viscoelastics.
Sources for these rules are the Highmark Medicare LCD L27482 and the AAO's Ophthalmic Coding Series Anterior Chamber Module.
Hope this helps.
John Uecke CPC, CPMA, CHA, COBS, CMIS, CMOM, OCS
NOVA Medical Billing, Inc.