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Complex Cataract

Carmel Posted Tue 07th of March, 2017 16:01:06 PM
I have a doctor who coded all her cases as complex but all that she used was preservative free epinephrine. I know that this doesn't qualify as a complex but I can't find the info I have in the past to support it. Has this changed in 2017?
SuperCoder Answered Wed 08th of March, 2017 01:44:12 AM

Greetings from SuperCoder.com!

 

Ask yourself these 4 questions when you're deciding whether to report 66982 or not:

 

  1. Is the pupil miotic?
  2. Is the patient very young, and still in the amblyogenic developmental stage?
  3. Does the IOL need extra support, such as permanent intraocular sutures or capsular tension rings?
  4. Does the ophthalmologist use dye to help him visualize the anterior chamber?

 

If the answers are "YES," you may be able to report 66982 instead of the lower-reimbursing 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis ...) for an extracapsular cataract removal.

 

Watch out: Don't report 66982 just because the ophthalmologist encounters a surgical complication, such as the need to perform a vitrectomy. A true complex cataract extraction is prospectively planned based on pre-existing conditions.

 

Bottom line: Report 66982 only if the ophthalmologist knows preoperatively that a more complex procedure is necessary and meets the requirements of the code descriptor. Documentation in the medical record prior to the surgery will support this decision.

 

Please feel free to write if you have any concern or questions.

 

Thanks.

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