CPT 66982, 66984, 66840, 66850, 66852, 66920 - Cataract Extraction (including Complex Cataract Surgery)


Coding and General Billing Requirements


Physicians and hospitals must report one of the following Current Procedural Terminology (Procedure ) codes on the claim:

66982 - Extracapsular cataract removal with insertion of intraocular lens prosthesis (one 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 with insertion of intraocular lens prosthesis (one stage procedure)

• 66984 - Extracapsular cataract removal with insertion of intraocular lens prosthesis (one 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


In addition, physicians inserting a P-C IOL or A-C IOL in an office setting may bill code V2632 (posterior chamber intraocular lens) for the IOL. Medicare will make payment for the lens based on reasonable cost for a conventional IOL. Place of Service (POS) = 11.
Medicare coverage for cataract extraction with Intraocular Lens implant (IOL) is based on services that are reasonable and medically necessary for the treatment of beneficiaries who have a cataract. Cataract patients mustmeet all the following criteria:

  • The patient has undergone a standardized formal measure of his visual functional status, the results of which suggest that the patient’s visual functional status can be improved commensurate with the risk of surgery by undergoing cataract extraction with IOL implant. Such testing can be performed with standardized measurement tools such as the Activities of Daily Vision Scale or the VF-14 questionnaire.
  • The patient has impairment of visual function due to cataract(s) resulting in:
    • Decreased ability to carry out activities of daily living such as reading, viewing television, driving or meeting occupational or vocational expectations.
    • Snellen visual acuity of 20/40 or worse. Not all patients with visual acuity of 20/40 or worse require cataract surgery because:
      • They are able to satisfactorily carry out their activities of daily living with changes in eyeglasses, lighting or other non-operative means.
      • The operative risk is not commensurate with the potential benefit to the patient.
      • Other eye disease such as macular degeneration or diabetic retinopathy rather than cataract is the limiting factor of visual function.
      • The patient has posterior segment disease requiring surgical or laser intervention and where the cataract is an impairment to visualization.

Generally, patients with visual acuity of 20/40 or better do not require cataract surgery to improve their ability to carry out activities of daily living. However, glare or other environmental factors may adversely affect some patients’ activities of daily living because a cataract is present and significantly diminishes function, even with Snellen acuity of 20/40 or better.

  • The patient has been educated about the risks and benefits of cataract surgery and the alternative to surgery, and has provided informed consent.
  • The patient has undergone an appropriate preoperative ophthalmologic evaluation which generally includes a comprehensive ophthalmologic exam and an A-scan ultrasound or partial coherence interferometry. Other ophthalmologic studies should be reserved for special situations such as:
    • Glare testing for patients with cataracts who complain of glare, yet measure good Snellen acuity when tested in an office circumstance.
    • B-scan for patients with dense cataracts which preclude visualization of the posterior segment of the eye including the vitreous and/or retina, but not limited to these.

Note: Medicare does not cover routine preoperative screening without substantiated signs or symptoms of disease. When the only diagnosis is cataract(s), Medicare does not cover testing other than one comprehensive eye examination (or a combination of brief/intermediate examinations not to exceed the charge of a comprehensive examination) plus an appropriate ultrasound scan.

The maximum appropriate interval between the preoperative examination and the date of surgery is three months in case there are significant changes in the patient’s health or vision. Patients should be educated to contact the ophthalmologist if they have a change in visual symptoms during the interval between the examination and surgery.

The following tests are generally not indicated in the preoperative workup for cataract surgery. If performed, the indications for their use must be documented in the patient’s medical record:

  • Contrast-sensitivity testing.
  • Potential vision testing.
  • Formal visual fields.
  • Fluorescein angiography.
  • External photography.
  • Corneal pachymetry/specular microscopy.
  • Specialized color vision tests.
  • Electrophysiologic tests.

Medicare would not expect to see bilateral cataract extractions routinely performed on the same day.
The following are contraindications to surgery for visually impairing cataract:
  • Glasses or visual aids provide satisfactory functional vision.
  • The patient’s lifestyle is not compromised by the cataract.
  • The patient is unable to undergo surgery because of coexisting medical or ocular conditions.
  • The patient does not desire surgery.
  • Surgery will not improve visual function.
  • A legal consent cannot be obtained.

There are several indications and limitations for use of code 66982:

  • A miotic pupil that will not dilate sufficiently to allow adequate visualization of the lens in the posterior chamber of the eye and that requires the insertion of four iris retractors through four additional incisions, Beehler expansion device, a sector iridectomy with subsequent suture repair of iris sphincter, or sphincterotomies created with scissors.
  • Pediatric cataract surgery, which may be more difficult intraoperatively because of an anterior capsule that is more difficult to tear, cortex that is more difficult to remove and the need for a primary posterior capsulotomy or capsulorrhexis. Furthermore, there is additional postoperative work associated with pediatric cataract surgery.
  • Extraordinary work that may occur during the postoperative period. This is the case with pediatric cases mentioned above and very rarely when there is extreme postoperative inflammation and pain.
  • Mature cataract requiring dye for visualization of capsulorrhexis.
  • Pre-existing zonular weakness requiring use of capsular tension rings or segments or intraocular suturing of the intraocular lens.


Medicare Benefit Summary

  • A conventional IOL implanted following cataract surgery.
  • Facility or physician services and supplies required to insert a conventional IOL following cataract surgery.
  • One pair of eyeglasses or contact lenses as a prosthetic device furnished after each cataract surgery with insertion of an IOL.



 Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:

  • Safe and effective.
  • Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
  • Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
    • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
    • Furnished in a setting appropriate to the patient’s medical needs and condition.
    • Ordered and furnished by qualified personnel.
    • One that meets, but does not exceed, the patient’s medical need.
    • At least as beneficial as an existing and available medically appropriate alternative.

Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
12X, 13X, 18X, 21X, 83X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.


CPT/HCPCS Codes
Note:
Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
66840©
Removal of lens material
66850©
Removal of lens material
66852©
Removal of lens material
66920©
Extraction of lens
66940©
Extraction of lens
66982©
Cataract surgery, complex
66983©
Cataract surg w/iol, 1 stage
66984©
Cataract surg w/iol, 1 stage Fee amount $600 - $750



Billing and Coding Guideline CPT CODE 66840 - 66984

Cataract removal codes are mutually exclusive of each other and can only be billed once for the same eye. Because CPT codes describing cataract extraction (66830-66984) are mutually exclusive of one another, providers may not report multiple codes for the same eye even if more than one technique is used or more than one code could be applicable. Only one code from this CPT code range may be reported for an eye. 


Example 1: For Date of Service (DOS) 10/20/09 the provider billed and received reimbursement for code 66852 LT modifier and also 66984 LT modifier. Since these codes are mutually exclusive of one another only one code should have been reimbursed. Per the NCCI Policy Manual CPT codes describing cataract extraction (66830-66984) are mutually exclusive of one another. Only one code from this CPT code range may be reported for an eye. Therefore Medicare recovered payment for CPT code 66984.


Example 2: For DOS 11/23/10 the provider billed and received reimbursement for 2 units of code 66984 RT modifier. Since cataract removal can only occur once per eye for the same date of service this would be an overpayment. Medicare would adjust the units down to 1 unit for this claim line.



For example, if the surgeon performing a cataract extraction (CPT code 66984) also provides anesthesia (CPT code 00142), the anesthesia service is not reported separately. Therefore, CPT code 00142 is bundled into CPT code 66984.



Example 3: Separate Injury A patient undergoes pterygium surgery in the right eye. During the 90-day global period, she is hit in the left eye with a bungee cord, causing a traumatic cataract and vitreous hemorrhage. Immediate surgery is scheduled. Correct coding for the exam. The appropriate level of E&M (9921X–57) or Eye code (9201X–57). Use of modifier. Modifier –57 indicates that this is the exam to determine the need for surgery. Correct coding for the surgery. CPT code 67036–79–LT (for the vitrectomy) and CPT code 66984–59–79–LT (for the cataract removal). Use of modifiers. NCCI edits bundle 66984 with 67036. When you know preoperatively that both procedures will be performed, it is appropriate to unbundle by appending modifier –59 to 66984. Modifier –79 is used to indicate that these surgeries are unrelated to the pterygium surgery. Know which code to list first. The rules for the reimbursement of multiple procedures mean payment for the code that is listed first will be 100 percent of its allowable; for the code listed second, 50 percent of its allowable. Therefore, the code with the highest allowable—in this case, vitrectomy— should be listed first. 

If Modifier 50 has been used then Medicare would pay 150% of allowed amount.


• UnitedHealthcare will cover the cataract surgery (including the cost of the conventional lens) and the patient is responsible for the cost of the  resbyopiacorrecting IOL to the extent it exceeds the cost of the conventional lens.

The proper facility coding of this procedure is as follows:

Cataract surgery: 66982 or 66984
Covered IOL: V2630-V2632
Non-covered IOL: V2797


Physicians would use CPT codes 66982 or 66984 to receive payment for cataract surgery


CATARACT CO-MANAGEMENT BILLING FOR MEDICARE

Essential elements of the transfer agreement from the optometrist should include the following:

1. Patient Name

2. Operative Eye

3. Nature of Operation

4. Transfer Date

5. Results of First Post-Operative Visit


Both doctors should retain copies of this documentation as part of the patients permanent records. They may also serve as a useful attachment on claims, as necessary.



In cataract surgery procedures (CPT codes 66984 and 66982), an IOL is implanted to replace the natural lens. A conventional IOL is focused to correct the patient’s distance vision but not other refractive errors such as astigmatism. A toric IOL replaces the natural lens and corrects astigmatism as well as distance vision, resulting in patients’ decreased postoperative  dependence on glasses or contact lenses. Medicare and most other insurance carriers specifically exclude coverage for the surgical correction of refractive errors, including astigmatism.

Use of modifiers. NCCI edits bundle

66984 with 67036. When you know preoperatively that both procedures will be performed, it is appropriate to unbundle by appending modifier –59 to 66984. Modifier –79 is used to indicate that these surgeries are unrelated to the pterygium  surgery.

Know which code to list first. The rules for the reimbursement of multiple procedures mean payment for the code that is listed first will be 100 percent of its allowable; for the code listed second, 50 percent of its allowable.


Therefore, the code with the highest allowable—in this case, vitrectomy— should be listed first.

MODIFIERS FOR CLAIMS SUBMISSION

Immediately following surgery, the surgeon can submit a claim for the surgical component of care using the appropriate CPT Code, i.e. 66984, and Modifier 54. This modifier is used to indicate the surgical event in a co-managed case. Medicare assigns 80% of the global fee to the intraoperative service. Later the surgeon will submit a claim for his/her portion of post-operative care. In order for this claim to be accurate, the surgeon needs to know the date the optometrist assumed responsibility for the remaining post-operative care (the transfer date noted above). This claim will be filed using the appropriate CPT Code, i.e. 66984, and Modifier 55, which indicates post-operative management only. After the optometrist has seen the patient for post-operative care, he/she will submit a claim for the postoperative care provided, using the appropriate CPT Code, i.e, 66984, and Modifier 55. Again, in order for the claim to be accurate the optometrist must know the date he/she assumed responsibility for postoperative care (the transfer date). 


Medicare uses chronology and number of days to calculate payment for care rendered by each doctor during the post-operative period (90 days). The fees submitted by the surgeon and optometrist will be different, depending on the number of days of post-operative care each one provided.

Co-Management Modifiers

When more than one physician furnishes services that are part of a global surgery fee package, the following modifiers are
required to identify services furnished by each provider of care:

o Modifier -54 - Surgical Care Only

o Modifier -55- Post-operative Care

Basic coverage requirement for the co-management of a patient is that the surgeon MUST initiate the notification to Medicare
by using modifier -54 with the claim for surgery, e.g., 66984-54. 

o The date of service should be the date of the surgical procedure. 


o The provider who provides the post-operative care bills the same CPT® code as the surgeon with modifier -55, e.g., 66984-55. 


Billing Guidelines

“Co-management” of Postoperative Care for Cataract Surgery (CPT 66984)

Providers should follow CMS billing guidelines. Following are the current billing guidelines as published by National Government Services relative to practitioners who share postoperative management with another practitioner following cataract surgery, CPT 66984.

The Alliance has noticed inconsistencies in billing for these services, therefore, these guidelines are offered to ensure appropriate reimbursement.


Modifier 55 - Postoperative Management Only:

If the practitioner who performs surgery relinquishes care after the surgery, he/she need only show the date of surgery and bill the surgical code(s) with modifier 54-Surgical Care Only (e.g. CPT 66984-54).

If the practitioner continues to care for the patient for some period following the surgery, he/she should bill the date of surgery, the surgical procedure with modifier 54 (indicating surgery only) and a separate line item with the date of surgery, surgical procedure code with modifier 55 (indicating postoperative care). In this case, it would be necessary to show the dates during the postoperative period for which he/she was responsible in Item 19 of the CMS-1500 Form. The “units” field (Item 24g of the CMS-1500 Form) should indicate the exact number of postoperative days the practitioner was responsible for care.

When a transfer of postoperative care occurs, the receiving practitioner may not bill for any part of the global service until he/she has provided at least one service. Once the practitioner has seen the patient, that practitioner may bill for the period beginning with the date on which he assumes care of the patient. The exact number of postoperative days should be given as “units” in Item 24g of the CMS-1500 Form or electronic equivalent. In this case, it would be necessary to show the dates during the postoperative period for which he/she was responsible in Item 19 of the CMS-1500 Form. The date of service should be indicated as the date of surgery. Allowance of the postoperative care for each practitioner will be according to the number of days each practitioner was responsible for the patient’s postoperative care.  2 Example of Billing co-management of postoperative car .



Payment for Services and Supplies

For an IOL inserted following removal of a cataract in a hospital, on either an outpatient or inpatient basis, that is paid under the hospital Outpatient Prospective Payment System (OPPS) or the Inpatient Prospective Payment System (IPPS), respectively; or in a Medicare-approved ambulatory surgical center (ASC) that is paid under the ASC fee schedule:

• Medicare does not make separate payment to the hospital or ASC for an IOL inserted subsequent to extraction of a cataract. Payment for the IOL is packaged into the payment for the surgical cataract extraction/lens replacement procedure.

• Any person or ASC, who presents or causes to be presented a bill or request for payment for an IOL inserted during or subsequent to cataract surgery for which payment is made under the ASC fee schedule, is subject to a civil money penalty.

• For a P-C IOL or A-C IOL inserted subsequent to removal of a cataract in a hospital, on either an outpatient or inpatient basis, that is paid under the OPPS or the IPPS, respectively; or in a Medicare-approved ASC that is paid under the ASC fee schedule:

• The facility shall bill for the removal of a cataract with insertion of a conventional IOL, regardless of whether a conventional, P-C IOL, or A-C IOL is inserted. When a beneficiary receives a P-C or A-C IOL following removal of a cataract, hospitals and ASCs shall report the same Procedure  code that is used to report removal of a cataract with insertion of a conventional IOL. Physicians, hospitals and ASCs may also report an additional HCPCS code, V2788, to indicate any additional charges that accrue when a P-C IOL or A-C IOL is inserted in lieu of a conventional IOL until January 1, 2008. Effective for A-C IOL insertion services on or after January 1, 2008, physicians, hospitals and ASCs should use V2787 to report any additional charges that accrue. On or after January 1, 2008, physicians, hospitals, and ASCs should continue to report HCPCS code V2788 to indicate any additional charges that accrue for insertion of a P-C IOL. See Section 120.2 for coding guidelines.

• There is no Medicare benefit category that allows payment of facility charges for services and supplies required to insert and adjust a P-C or A-C IOL following removal of a cataract that exceed the facility charges for services and supplies required for the insertion and adjustment of a conventional IOL.

• There is no Medicare benefit category that allows payment of facility charges for subsequent treatments, services and supplies required to examine and monitor the beneficiary who receives a P-C or A-C IOL following removal of a cataract that exceeds the facility charges for subsequent treatments, services and supplies required to examine and monitor a beneficiary after cataract surgery followed by insertion of a conventional IOL.


A - For a P-C IOL or A-C IOL inserted in a physician's office

- A physician shall bill for a conventional IOL, regardless of a whether a conventional, P-C IOL, or A-C IOL is inserted (see section 120.2, General Billing Requirements)

- There is no Medicare benefit category that allows payment of physician charges for services and supplies required to insert and adjust a P-C or A-C IOL following removal of a cataract that exceed the physician charges for services and supplies for the insertion and adjustment of a conventional IOL.

- There is no Medicare benefit category that allows payment of physician charges for subsequent treatments, service and supplies required to examine and monitor a beneficiary following removal of a cataract with insertion of a P-C or A-C IOL that exceed physician charges for services and supplies to examine and monitor a beneficiary following removal of a cataract with insertion of a conventional IOL.



B - For a P-C IOL or A-C IOL inserted in a hospital

- A physician may not bill Medicare for a P-C or A-C IOL inserted during a cataract procedure performed in a hospital setting because the payment for the lens is included in the payment made to the facility for the surgical procedure.


- There is no Medicare benefit category that allows payment of physician charges for services and supplies required to insert and adjust a P-C or A-C IOL following removal of a cataract that exceed the physician charges for services and supplies required for the insertion of a conventional IOL.


ICD-9-CM Codes That Support Medical Necessity
The CPT/HCPCS codes included in this LCD will be subjected to “procedure to diagnosis” editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS code 66982:
Covered for:
364.23
Lens induced iridocyclitis
364.51
Essential or progressive iris atrophy
Note: Use 364.51 if the operative note indicates the use of an endocapsular ring to partially occlude the pupil.
364.55
Miotic cysts of the apillary margin
Note: Use 364.55 if the operative note indicates micro iris hooks were inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, or sector iridotomy with suture repair of iris sphincter.
364.57
Degenerative changes of the ciliary body
Note: Use 364.57 if the operative note indicates permanent intraocular suture or a capsular support ring was employed to place the IOL in a stable position.
364.59
Other iris atrophy
Note: Use 364.59 if the operative note indicates the use of an endocapsular ring to partially occlude the pupil.
364.75
Pupillary abnormalities
Note: Use 364.75 if the operative note indicates the use of an endocapsular ring to partially occlude the pupil.
364.76
Iridodialysis
Note: Use 364.76 if the operative note indicates a capsular support ring was employed or an endocapsular support ring was used to partially occlude the pupil.
364.81
Floppy iris syndrome
364.89
Other disorders of iris and ciliary body
Note: Use 364.81 or 364.89 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
364.9
Unspecified disorder of iris and ciliary body
Note: Use 364.9 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.00
Non-senile cataract, unspecified
Note: Use 366.00 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.01
Anterior subcapsular polar cataract
Note: Use 366.01 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.02
Posterior subcapsular polar cataract
Note: Use 366.02 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.03
Cortical, lamellar, or zonular cataract
Note: Use 366.03 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.04
Nuclear cataract
Note: Use 366.04 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.09
Other and combined forms of non-senile cataract
Note: Use 366.09 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.10
Senile cataract, unspecified
Note: Use 366.10 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.11
Senile cataract; pseudoexfoliation of lens capsule
Note: Use 366.11 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.13
Anterior subcapsular polar senile cataract
Note: Use 366.13 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.14
Posterior subcapsular polar senile cataract
Note: Use 366.14 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.15
Cortical senile cataract
Note: Use 366.15 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
OR
Use this code when Trypan Blue or isocyanine green is employed to enhance visualization.
366.16
Nuclear sclerosis
Note: Use 366.16 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.17
Total or mature cataract
Note: Use 366.17 if the operative note indicates dye was used to stain the anterior capsule.
366.18
Hypermature cataract
Note: Use 366.18 with 365.51, phacolytic glaucoma or dye staining of the anterior capsule.
366.19
Other and combined forms of senile cataract
Note: Use 366.19 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
OR
Use this code when Trypan Blue or isocyanine green is employed to enhance visualization.
366.20
Traumatic cataract, unspecified
Note: Use 366.20 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.21
Localized traumatic opacities
Note: Use 366.21 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular suture, or a capsular support ring was employed.
366.22
Total traumatic cataract
Note: Use 366.22 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures, or a capsular support ring was employed.
366.23
Partially resolved traumatic cataract
Note: Use 366.23 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.30
Cataracta complicata, unspecified
Note: Use 366.30 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, IOL implant was supported by using permanent intraocular sutures, a capsular support ring was employed, or a primary posterior capsulorrhexis was performed.
366.32
Cataract in inflammatory disorders
Note: Use 366.32 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, or sector iridotomy with suture repair of iris sphincter.
366.33
Cataract with neovascularization
Note: Use 366.33 if the operative note indicated micro iris hooks were inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, or sector iridotomy with suture repair of iris sphincter.
366.41
Diabetic cataract
Note: Use 366.41 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.42
Tetanic cataract
Note: Use 366.42 if the operative note or postoperative records indicate an extraordinary amount of work was involved in the preoperative or postoperative care.
366.43
Myotonic cataract
Note: Use 366.43 if the operative note or postoperative records indicate an extraordinary amount of work was involved in the preoperative or postoperative care.
366.44
Cataract associated with other syndromes
Note: Use 366.44 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.45
Toxic cataract
Note: Use 366.45 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
366.46
Cataract associated with radiation and other physical influences
Note: Use 366.46 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.
379.32
Subluxation of the lens
Note: Use 379.32 if the operative note indicates the IOL was supported by using permanent intraocular sutures or a capsular support ring.
379.33
Anterior dislocation of lens
Note: Use 379.33 if the operative note indicates the IOL was supported by using permanent intraocular sutures, or a capsular support ring was employed.
379.34
Posterior dislocation of lens
Note: Use 379.34 if the operative note indicates the IOL was supported by using permanent intraocular sutures, or a capsular support ring was employed.
379.40
Abnormal pupillary function, unspecified
Note: Use 379.40 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, or an artificial prosthetic iris was placed in the eye.
379.41
Anisocoria
Note: Use 379.41 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, or an artificial prosthetic iris was placed in the eye.
379.42
Miosis (persistent), not due to miotics
Note: Use 379.42 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, or an artificial prosthetic iris was placed in the eye.
379.43
Mydriasis (persistent), not due to mydriatics
Note: Use 379.43 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, or an artificial prosthetic iris was placed in the eye.
379.45
Argyll Robertson pupil, atypical
Note: Use 379.45 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, or an artificial prosthetic iris was placed in the eye.
379.46
Tonic pupillary reaction
Note: Use 379.46 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, or an artificial prosthetic iris was placed in the eye.
379.49
Other anomalies of pupillary function
Note: Use 379.49 if the operative note indicates the use of micro iris hooks inserted through four separate incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, or an artificial prosthetic iris was placed in the eye.
743.36
Anomalies of lens shape spherophakia
Note: Use 743.36 if the operative note indicates use of IOL implant was supported by using permanent intraocular sutures or a capsular support ring was employed.
743.37
Congenital ectopic lens
Note: Use 743.37 if the operative note indicates IOL implant was supported by using permanent intraocular sutures or a capsular support ring was employed.
743.45
Aniridia
Note: Use 743.45 if the operative note indicates the IOL was supported in the eye by using permanent intraocular sutures, a capsular support ring was employed or an endocapsular ring was used to partially occlude the pupil.
743.46
Other specified anomalies of the iris and ciliary body
Note: Use 743.46 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil.

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