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66982

Alea Posted Tue 24th of April, 2012 18:41:27 PM

The cataract surgery ended up being complicated due to pt having floppy iris, side effects of a heart medication. can this bill as complex? (no special ring or dye was used)
if 2 unrelated surgeries were done on same day on same eye do I use a modifier other than the eye mod e.g. RT?
thanks

SuperCoder Answered Tue 24th of April, 2012 21:30:14 PM

The references I've seen say floppy iris isn't always a reason to use 66982. Without the special ring, etc., payers may not find the complex code medically necessary. E.g., here's a quote from WPS LCD L30159:

"Indications and limitations for the use of CPT code 66982.
1. A miotic pupil which will not dilate sufficiently to allow adequate visualization of the lens in the posterior chamber of the eye and which requires the insertion of iris retractors through additional incisions, mechanical expansion of the pupil, a sector iridectomy with subsequent suture repair of iris sphincter, use of a Malyugian ring and multiple iris sphincterotomies created with scissors. This situation is most commonly encountered in Intraoperative FLOPPY IRIS Syndrome (ICD-9 364.81), as a result of Tamsulosin (Flomax) use or medications with similar side effects. ..."

For 2 procedures on the same eye, modifier use probably depends on codes involved. E.g., if the codes/relevant payer require modifier 51.

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