Cataracts disease of the eye causes the clouding of the lens of the eyeball and removal of these lenses of the eye is called cataract surgery. It is observed that over half of the people in America over age 80 have either had a cataract or cataract surgery hence medical billing for cataract surgery accounts for a large volume of the claims that ophthalmology medical billing companies process.
In this brief, you will understand Medical Billing for Cataract Surgery with some of the main CPT codes.
CPT codes for Extraction of lens and lens material:
|
CPT Codes |
Description |
|
66850 |
Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration |
|
66920 |
Removal of lens material; intracapsular |
|
66940 |
Removal of lens material; extracapsular (other than 66840, 66850, 66852) |
CPT codes for cataract extractions With implant:
|
CPT Codes |
Description |
|
66982 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage 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 development stage |
|
66983 |
Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure) |
|
66984 |
Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure) manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification) |
|
66985 |
Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract extraction |
|
66986 |
Exchange of intraocular lens |
Disorders of the lens (H25-H28)
|
H25 |
Age-related Cataract |
|
H26 |
Other Cataract |
|
H27 |
Other disorders of lens |
|
H28 |
Cataract in diseases classified elsewhere |
ASCs determine which CPT and ICD-10 codes are most appropriate to report on the claim the operative report.
Documenting complex Cataract Surgery case
Most of the ophthalmologists fear to bill for a complex case (CPT code 66982) but you shouldn’t. You need to support the case with proper documentation. Although not every Medicare Administrative Contractor has a Local Coverage Determination policy for complex cataract surgery.
Following four questions to determine if your case is complex or not:
- Is it a miotic pupil that will not dilate sufficiently thus requiring the use of special instruments?
- Does the IOL need additional support, such as a capsular tension ring or intraocular sutures?
- Is this a pediatrics case that includes the implantation of the IOL?
- Is the cataract considered mature, requiring the use of dye?
If you find ”Yes” for any of the above questions then submit CPT code 66982. You must be aware that this code selection is not based on the difficulty of the case but rather on the use of additional devices or if you are operating on children.
Many times you know before surgery whether or not the case will be complex; however, if you determine intraoperatively, be sure the facility updates its claim and submits the case as “complex”. Both you and the facility should submit the same CPT code to the payer.
If you face difficulties in Medical Billing for Cataract Surgery then you can really on us, we have experienced coders in medical billing and coding and well-versed in the CPT and ICD-10 codes for ophthalmology.
FAQs:
1: What is cataract surgery?
Cataract surgery involves the removal of the clouded lens of the eye, often performed using techniques like phacoemulsification or extracapsular extraction.
2: What are the key CPT codes for cataract surgery?
Key CPT codes include 66850 for phacofragmentation, 66982 for complex cataract removal with lens insertion, and 66984 for extracapsular cataract removal with lens insertion.
3: How do I document a complex cataract surgery case?
To document complexity, assess factors like pupil dilation issues, need for additional lens support, pediatric cases, or mature cataracts requiring dye.
4: How can I determine if a case is complex?
If any of the following apply—insufficient pupil dilation, need for additional support devices, pediatric cases, or mature cataracts—consider the case complex and use CPT code 66982.
5: What should I do if I face billing difficulties for cataract surgery?
If you encounter challenges in medical billing, consider seeking assistance from experienced coders who are knowledgeable about CPT and ICD-10 codes for ophthalmology.
