Can I bill 66185 Revision if doc just trim the tube to facilate the cataract?
PREOPERATIVE DIAGNOSES: 1. Visually significant cataract, right eye.
2. Status post Ahmed valve implantation.
3. Neovascular glaucoma, right eye.
POSTOPERATIVE DIAGNOSES: 1. Visually significant cataract.
2. Small pupil with synechial adhesions between the pupillary margin and lens capsule.
3. Silicone tube with Ahmed valve going too long getting into the visual axis to some degree crossing the pupillary margin.
PROCEDURES PERFORMED: 1. Phacoemulsification with a posterior chamber intraocular lens implantation, right eye
2. Synechiolysis with pupilloplasty, right eye.
3. Ahmed valve revision to trim the tube of the Ahmed valve, so as to facilitate the cataract extraction.
DESCRIPTION OF PROCEDURE: After informed consent was obtained from the patient, the patient was wheeled into the operating room. The right eye was prepped and draped in a standard fashion for this procedure. Lids and eyelashes were secured with the help of a lid speculum. A preservative-free lidocaine, one drop x3 was placed on the surface of the cornea and conjunctiva. Examination of the anterior segment was performed under the microscope. The cornea was cleared and anterior chamber was deep and well formed. Silicone tube with Ahmed valve was getting into the cornea into the supratemporal quadrant crossing the pupillary margin. The pupil itself was approximately 4-mm with synechial adhesions that were present between the pupillary margin and lens capsule.
A paracentesis was performed in the supratemporal quadrant. Viscoelastic was injected into the anterior chamber. A 2.75-mm Alcon keratome was used to enter the anterior chamber and inferotemporal quadrant. Using the viscoelastic cannula, the synechiolysis was performed. The pupil was then stretched to approximately 6-mm. Then using a long _____ (02:05) Vannas, the silicon tube with Ahmed valve was cut short, so as to we behind the pupillary margin and not to obscure the cataract extraction. The cut silicon tube was then trimmed and silicone tube was then extracted and grabbed with the help of Utrata forceps and brought out of the eye. Attention now was directed towards the performing glaucoma surgery.
Continuous capsulorrhexis was performed with the help of cystotome. The hydrodissection was performed with the help of BSS on a cannula. The nucleus was removed with the help of phacoemulsification. Remaining cortical material was removed with the help of irrigation-aspiration. A posterior chamber implant was inserted into the capsular bag without any complications. The rest of the viscoelastic was removed with the help of irrigation-aspiration. Posterior chamber implant was inserted into the capsular bag without any complications. The rest of the viscoelastic was removed from the anterior chamber with the help of irrigation-aspiration. The wound was hydrated and closed with the help of a single interrupted 10-0 nylon suture. At the end of the operation, the cornea was cleared. The anterior chamber was deep and well formed. The intraocular lens was in stable position within the capsular bag and there was a bright red reflex. A drop of pilocarpine and TobraDex were placed in the eye, and the eye was covered with the help of a shield. The patient was transferred to the recovery room without any complications. Please note that the silicone tube was in perfect position lying on top of the eye, was away from the pupillary margin at the end of the procedure.
My first thought would be no because he says that he trimmed the tube to facilitate the cataract extraction. So He had to do that to complete the procedure. I would use complex cat code. 66982