Coding IOL procedures can be tricky - and errors can cost you more than $800
If your ophthalmologist inserts an intraocular lens (IOL) prosthesis after a pars plana partial vitrectomy and removal of a dislocated lens, don't count on a single CPT code to get reimbursed for all of the work.
To get paid for that IOL insertion - and for other complex procedures like lens repositionings and piggyback lens insertions - you'll need a strong grasp of the CPT code descriptions and modifiers. Our experts help you find your way through several difficult IOL scenarios.
Dislocated Lens Replacement
Scenario: The ophthalmologist removes a dislocated natural lens and places an IOL prosthesis.
Solution: IOL insertion is included in the cataract removal codes, says Sheila Cutler, patient information supervisor for the department of ophthalmology at the University of Kansas Medical Center in Kansas City. Code the procedure according to the technique and approach used.
If the procedure meets one of the criteria for a complicated cataract extraction, report 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one-step procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex, requiring devices or techniques not generally used in routine cataract surgery [e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis] or performed on patients in the amblyogenic developmental stage), Cutler says.
If the procedure is not a complicated extraction and is performed in a single session, for an intracapsular removal you should report 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis [one-stage procedure]), Cutler says, or for an extracapsular removal report 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [one-stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification]).
If the procedure is performed in two sessions - the lens removal on one day and the lens insertion on another day - report 66930 (Removal of lens material; intracapsular, for dislocated lens) for the day the dislocated lens is removed, and 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal) with modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) appended for the day the IOL is placed, Cutler says.
IOL Following Lens Removal and Minor Vitrectomy
Scenario: The ophthalmologist removed a dislocated lens through a pars plana approach, performing a minor posterior vitrectomy to aid in the lens removal. He also inserted an IOL.
Solution: For the lens removal, you might immediately think of CPT code 66852 (Removal of lens material; pars plana approach, with or without vitrectomy). The problem is that code doesn't accurately describe all the work performed - 66852 doesn't mention the IOL.
To fully describe the work done, you'll have [...]