Cataract Surgery in Ophthalmology Coding and Billing Forum

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Cataract Surgery

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Nicole1765

Cataract Surgery

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Posts: 37

Jun 13 08 5:53 AM

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I was at a seminar recently and a doctor spoke about billing cataract surgery. When a patient is on alpha-antagonists such as Flomax, Avodart, etc., which puts the patient at risk for a floppy iris syndrome. Because of the risk, the doctor that was speaking said when he has a patient on these medications he bills as a complex cataract surgery, due to the risk of floppy iris syndrome and proper percautions need to be taken to avoid this from happening. Does anyone else follow these same guidelines when billing cataract surgery?

tlands

Complicated Cataract Surgery reporting

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Posts: 13

Jun 13 08 8:41 PM

Nicole, It would be dependent on accurate documentation supporting the code selection and what code is being used for "complex" -- the addition of modifier 22? I do not find a specific code indicate the difference between routine verses complex. When you look at modifier 22 description: Increased Procedural Services: When the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. Documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). Note: This modifier should not be appended to an E/M service. I believe the speaker would be correct because the medication is adding additional "technical difficulty" to the procedure -- just be sure to clearly documnet to medical necessity for modifier 22 in the Operative Report.

Tina

mike nifo

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Posts: 18

Jul 23 08 6:26 PM

66982-complex cataract surgery

66984-"routine" cataract surgery

biller66

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Posts: 197

Jul 24 08 4:49 PM

This is from National Govnt Services (formerly Empire Medicare). Note that it is a future LCD. While floppy iris is on the approved list, risk for it is not (high risk drugs etc). See the documentation requirements below (ICD-9 364.81). See the entire LCD: http://www.ngsmedicare.com/NGSMedicare/ngslcd/draft/L26853_active_lcd.htm
I would make sure documentation of any special procedures performed is present. As the physician, I would petition for additional appropriate ICD-9 (s) be added because it does not appear that any are listed on this LCD. Check your carriers site.
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For CPT code 66982, complex cataract extraction, to be reasonable and necessary, the procedure should require devices or techniques not generally used in routine cataract surgery. Please see examples in the table below.

ICD-9-CM	DOCUMENTATION REQUIREMENTS for COMPLEX CATARACT SURGERY (CPT Code 66982)
364.23, 364.51, 364.59, 364.75	Report if the operative note indicates the use of an endocapsular ring to partially occlude the pupil.
364.55, 366.32, 366.33	Report if the operative note indicates micro iris hooks were inserted through four (4) separate corneal incisions, Beechler or similar expansion device, synechialysis utilizing papillary stretch maneuvers or, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of the iris sphincter.
364.57	Report if the operative note indicates that a permanent intraocular suture or a capsular support ring was employed to place the intraocular lens in a stable position.
364.76	Report if the operative note indicates a capsular support ring was employed or an endocapsular support ring was used for partial occlusion of the pupil.
364.81, 364.89, 364.9, 366.00, 366.01, 366.02, 366.03, 366.04, 366.09, 366.10, 366.11, 366.13, 366.14, 366.16, 366.19, 366.23, 366.41, 366.44, 366.45, 366.46, 743.46	Report if the operative note indicates the use of micro iris hooks inserted through four (4) separate cornea incisions, use of a Beechler or similar expansion device, synechialysis utiliziaing papillary stretch maneuvers creation of multiple sphincterotomies with scissors, a sector iridotomy with suture repair of iris sphincter was performed, or a permanent intraocular suture, capsular support ring, or endocapsular support ring was used for partial occlusion of the pupil.
366.17	Report if the operative note indicates dye was used to stain the anterior capsule.
366.18	This code must be used with 365.51 - Phacolytic glaucoma or dye staining of the anterior capsule.
366.20, 266.21, 366.22,366.30	Report if the operative note indicates micro iris hooks were inserted through four (4) separate corneal incisions, Beechler or similar expansion device, synechialysis utilizing papillary stretch maneuvers, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, intraocular lens implant was supported by using a permanent intraocular sutures, a capsular support ring was employed or a primary posteriod capsulorhexis was performed.
366.42, 366.43	Report if the operative note or postoperative records indicate an extraordinary amount of work was involved in the preoperative or postoperative care.
379.32, 379.33, 379.34, 743.36, 743.37	Report if the operative note indicates: the intraocular lens was supported by using permanent intraocular sutures or a capsular support ring.
379.40-379.49	Report if the operative note indicates the use of micro iris hooks inserted through four (4) separate incisions, Beechler or similar expansion device, synechialysis utilizing papillary stretch maneuvers, multiple sphincterotomies created with scissors, a sector iridotomy with suture repair of the iris sphincter, or an artificial prosthetic iris was placed in the eye.
743.45	Report if the operative note indicates the intraocular lens was supported in the eye by using permanent intraocular sutures, a capsular support ring was employed, or an endocapsular ring was used to for partial occlusion of the pupil.

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