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Thread: trypan blue in cat/iol sx

  1. #1
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    Default trypan blue in cat/iol sx

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    Can a complex cataract surgery 66982 be coded when trypan blue is used?

  2. #2
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    Default trypan blue

    Hi! Yes--Tripan blue does constitute using 66982 for complex cataract. According to Ophthalmology coding alert, 2008, ask the following in order to apply 66982:
    Is the pupil miotic?
    Is the patient very young and still in amblyogenic developmental stage?
    Does the IOL need extra support, such as permanent intraocular sutures or capsular tension rings?
    Does the surgeon use dye to help him visualize the anterior chamber? TRYPAN BLUE

    Hope this is helpful to you.

  3. #3
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    Default

    Thanks for your help. I also found the answere in:

    http://www.wpsmedicare.com/j5macpart...9_ophth020.pdf

  4. #4
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    Default

    For any one else interested in this issue here is what I have found most recently - rather definitive - a 2016 AMA update to CPT Assist on the matter:

    Here’s the article from CPT Assistant March 2016, page 10

    Question: Does the use of Trypan Blue dye to stain dense cataract justify the use of a complicated cataract code 66982, Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage?

    Answer: No, the additional work of instilling and removing Trypan Blue dye from the anterior segment though an additional surgical step does not reach the threshold of physician time, work, or intensity necessary to report the complex cataract code. Indications that justify reporting a complex cataract surgery (66982) includes:

    1. The presence of a miotic pupil that will not dilate sufficiently to allow operative access to the lens, which requires the insertion of one of the following: four iris retractors through four additional incisions; a Beehler expansion device; a sector iridectomy with subsequent suture repair of; an iris sphincter; or sphincterotomies created with scissors.
    2. The presence of a disease state that produces lens support structures that are abnormally weak or absent, which requires the need to support the lens implant with permanent intraocular sutures, or, alternately, a capsular tension ring may be necessary to allow placement of an intraocular lens.
    3. Pediatric cataract surgery

  5. #5
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    Lexington Kentucky Chapter
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    Default Use of Trypan Blue

    Quote Originally Posted by Kelly_Josephine View Post
    For any one else interested in this issue here is what I have found most recently - rather definitive - a 2016 AMA update to CPT Assist on the matter:

    Here’s the article from CPT Assistant March 2016, page 10

    Question: Does the use of Trypan Blue dye to stain dense cataract justify the use of a complicated cataract code 66982, Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage?

    Answer: No, the additional work of instilling and removing Trypan Blue dye from the anterior segment though an additional surgical step does not reach the threshold of physician time, work, or intensity necessary to report the complex cataract code. Indications that justify reporting a complex cataract surgery (66982) includes:

    1. The presence of a miotic pupil that will not dilate sufficiently to allow operative access to the lens, which requires the insertion of one of the following: four iris retractors through four additional incisions; a Beehler expansion device; a sector iridectomy with subsequent suture repair of; an iris sphincter; or sphincterotomies created with scissors.
    2. The presence of a disease state that produces lens support structures that are abnormally weak or absent, which requires the need to support the lens implant with permanent intraocular sutures, or, alternately, a capsular tension ring may be necessary to allow placement of an intraocular lens.
    3. Pediatric cataract surgery
    I guess there is a difference of opinion, as JCAPHO/AAOE state:

    The use of dye to stain the capsule for a hypermature cataract. Yes — use of dye in a white or mature cataract necessary for capsulorrhexis. Documentation of the reason for using Trypan Blue dye — such
    as mature, count fingers cataract, no red reflex, etc. — is strongly recommended.

    And:

    Q. If I use vision blue during cataract surgery, it qualifies for complex surgery, right?
    A. Not necessarily. Those payers who have LCDs state it is for the mature cataract where vision blue is used for better visualization.

    {Ophthalmic Coding Series Specialty Topics – 2015: Cataract/Anterior Segment}

    (Yes, I realize this is from 2015, but I haven't seen a change in wording for six or seven years, and see no changes on the horizon from this body.)

    David Keown, CPC, OCS

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