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vitrectomy during cataract removal

  1. #1
    Default vitrectomy during cataract removal
    Medical Coding Books
    Would the addition of a vitrectomy being performed during a cataract removeal be enough to support coding a 66982 rather than a 66984?
    Thanks so much.

  2. #2
    Lexington Kentucky Chapter
    Quote Originally Posted by cynthiaj54 View Post
    Would the addition of a vitrectomy being performed during a cataract removeal be enough to support coding a 66982 rather than a 66984?
    Thanks so much.
    Depending on method used, you could code these as separate procedures and append modifier -59 to your cataract code (and yes, 66982 would be appropriate if devices or techniques not normally used in routine cataract surgery are required, for example iris expansion devices, suture support of intraocular lens, or primary posterior capsulorrhexis.)

    Hope this helps!

    David Keown, CPC, OCS

  3. Default RE: vitrectomy during cataract removal
    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.
    NOVA Medical Billing, Inc.

  4. #4
    I don't know if it matters, but an ASC can bill for the vitrectomy w/cataract surgery.
    Anastasia, CPC, CASCC, COBGC

  5. Default
    I have never heard of ASCs being able to get around CCI edits before, the only possible exception would be that they are billing for two seperate providers, performing two distinct procedures due to two differing pathologies all on the same patient; in short no, I can not see an ASC being able to bill for an the vitrectomy w/cataract surgery.

    John Uecke
    NOVA Medical Billing

  6. #6
    Yes, they are billable & paid, the same provider. I have 7 years of experience doing it. There are instances where the provider and facility code differently. We have had no issues with this. Code 67010-59 Try it.
    Last edited by Anastasia; 03-08-2011 at 06:45 PM.
    Anastasia, CPC, CASCC, COBGC

  7. Default
    You could bill for the 67010 ONLY if this was planned before and documented prior to the surgery. You cannot if it's a complication during surgery and it certainly does not make for a complex cataract. I agree with John.

    Now, if you're coding a PPV - 67036 for example, then that is separately billable, even if done by the same surgeon.

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