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Piggy Back IOL

Atlantic Posted Wed 10th of October, 2012 18:34:32 PM

The Doctor has performed Cataract removal and insertion previously for a patient. Billed as 66984. Patient is having a piggy back IOL inserted. Patients complaints are Iritis, Eye Pain and PVD.
What CPT and DX is correct in this situation?

SuperCoder Answered Wed 10th of October, 2012 19:36:25 PM

If the ophthalmologist is inserting an IOL implant in a patient who had cataract surgery previously but did not have a lens implanted at the time of the previous surgery, report 66985 (Insertion of intraocular lens prosthesis [secondary implant], not associated with concurrent cataract removal). For example, if complications during the original cataract surgery prevented the surgeon from implanting the IOL at that time, he may need to perform 66985 later on.

You should also report 66985 if the ophthalmologist is inserting a piggyback IOL after a previous cataract surgery. But if the ophthalmologist inserts the piggyback IOL during cataract surgery, CPT directs you to 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis, manual or mechanical technique, complex, requiring devices or techniques not generally used in routine cataract surgery or performed on patients in the amblyogenic developmental stage), 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis) or 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis, manual or mechanical technique).

However: If the ophthalmologist is exchanging a previously implanted IOL, report 66986 (Exchange of intraocular lens). This procedure is rare, but it’s necessary in some cases--for example, if the previous implant turns out to be the wrong power, or if the lens gets dislocated and the ophthalmologist can’t reposition it safely. Do not report an additional code for removing the previous lens; it is included in 66986.

Atlantic Posted Wed 10th of October, 2012 19:56:03 PM

Just to clarify; the patient did indeed have an IOL implanted with the cataract extraction surgery.
The piggyback lens is now being implanted due to other complications. The correct coding is still 66985 ?
With DX of complications? And why is it that this code does not have a LCD listed in Novitas?

SuperCoder Answered Wed 10th of October, 2012 20:11:00 PM

The correct coding in this case is 66986. Since a previously implanted IOL is removed and replaced by a new one, this code is viable. Please see the last paragraph.

Dx-998.53-V45.61

Atlantic Posted Thu 11th of October, 2012 12:48:19 PM

The procedure will require a second IOL implant over the original IOL implant. The original
IOL remains intact.

SuperCoder Answered Thu 11th of October, 2012 17:56:22 PM

Yes,in this sceanrio 66985 fits well with 998.53 and V45.61.You should also report 66985 if the ophthalmologist is inserting a piggyback IOL after a previous cataract surgery.

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