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 Some of the codes may apply to rare procedures, but are provided here for reference. Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Cost of the five most common ASC procedures: 1. End Users do not act for or on behalf of the CMS. Results and interpretation of specialized ophthalmic studies that are, Article - Billing and Coding: Cataract Surgery in Adults (A57195). All Rights Reserved (or such other date of publication of CPT). The operative note indicates the use of micro iris hooks inserted through four (4) or more separate cornea incisions, use of an iris dilator device, synechiolysis utilizing pupillary 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. required field. Note: +0376 is an add-on code and cannot be used independently. If you combine cataract surgery with insertion of a Hydrus (Ivantis), iStent (Glaukos), or iStent Inject, submit 66991 if the cataract surgery is traditional and 66989 if it is complex. End User License Agreement: Importantly, for the surgeon (not the facility) the cataract and IOL codes 66982/66984 will be cut by about 15 percent for 2020. For CPT code 66982 and 66987, complex cataract extraction, to be reasonable and necessary, the procedure should require devices or techniques not generally used in routine cataract surgery. While every effort has been made to provide accurate and The AMA assumes no liability for data contained or not contained herein. Removal of implanted material, anterior segment of eye 67121. AHA copyrighted materials including the UB‐04 codes and Articles often contain coding or other guidelines that are related to a Local Coverage Determination (LCD). If cataract extraction is performed due to anisometropia, the medical record must substantiate the presence of significant aniseikonia secondary to anisometropia arising from the first cataract extraction with IOL implant. The first is 66987, which is defined as extracapsular cataract removal with insertion of intraocular lens prosthesis (a 1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, A CPT code 66982 is described as "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 copied without the express written consent of the AHA. Ancillary tests that are not routinely indicated in the preoperative workup for cataract surgery (see Specialized Ophthalmic testing) will not be considered a covered benefit if performed unless medical necessity is defended by a clear statement in the patient's record. 66991 Extracapsular cataract removal w/IOL insertion; with insertion of intraocular (e.g., trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more Both 66989 and 66991 are combination codes (they take two codes and combine them into a single code). Know the codes: Here are some of the main CPT codes for cataract extractions with and without implant: Extraction of lens and lens material: 66850 Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration 66920 Removal of lens material; intracapsular Extracapsular cataract removal with intraocular lens prosthesis; without endoscopic cyclophotocoagulation ASCs: $320 HOPDs: $532 2. Absence of a Bill Type does not guarantee that the You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Explore TEPEZZA (teprotumumab-trbw) nowfor your patients with this serious, progressive disease. You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. used to report this service. TEPEZZA is a trademark owned by or licensed to Horizon. 2022 Horizon Therapeutics plc P-TEP-US-00805 12/22, By David B. Glasser, MD, Academy Secretary for Federal Affairs, Michael X. Repka, MD, MBA, Academy Medical Director for Governmental Affairs, and Sue Vicchrilli, COT, OCS, OCSR, Academy Director of Coding and Reimbursement, MIGS UpdateHow to Code for Combined Glaucoma Procedures, Instruction Courses and Skills Transfer Labs, Program Participant and Faculty Guidelines, LEO Continuing Education Recognition Award, What Practices Are Saying About the Registry, Provider Enrollment, Chain and Ownership System (PECOS), Subspecialty/Specialized Interest Society Directory, Subspecialty/Specialized Interest Society Meetings, Minority Ophthalmology Mentoring Campaign, Global Programs and Resources for National Societies, Dr. Richard Mills' Opinions, 2002 to 2016. for your patients with this serious, progressive disease. American Journal of Ophthalmology 1992; title 21. Please enable "JavaScript" and revisit this page or proceed with browsing CMS.gov with Extracapsular cataract removal w/IOL insertion; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more During an intracapsular cataract extraction (ICCE), the entire natural lens and capsule that holds it in place are removed. The medical record and/or test results documenting medical necessity should be maintained and made available on request. An official website of the United States government. To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom Extra-capsular cataract extraction 11 63.18 7.65 50 80 Vitreoretinal surgery 11 148. Glove perforations in 19 Food and Drug Administration. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. Stages. Student reviews 100% (2 ratings) Thorough explanation Show other answers (1) descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work 66982- Extracapsular Cataract removal with insertion of intraocular lens prosthesis (1 stage procedure) manual or mechanical technique (EG, irrigation and aspiration or phacoemulsification, complex requiring devices or techniques not generally used in routing cataract . Coding Information:Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. All rights reserved. Self-Administered Drug (SAD) Exclusion List articles list the CPT/HCPCS codes that are excluded from coverage under this category. You can use your browser's Print function (Ctrl-P on a PC or Command-P on a Mac) to view a print preview and then select PDF as the output. misshapen pupil after cataract surgery. The page could not be loaded. Revenue Codes are equally subject to this coverage determination. CPT Code 66989 in section: Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification) Home Codes CPT viewing Tue Apr 11, 2023 Similarly, a particularly dense cataract that required extra surgical time to address would not qualify. The extracapsular cataract extraction (ECCE) surgical procedure is used primarily for advanced cataracts where the lens is too dense to dissolve into fragments. 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. GOVERNMENT AND ITS EMPLOYEES ARE NOT LIABLE FOR ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION, PRODUCT, OR PROCESSES Instructions for enabling "JavaScript" can be found here. If you are looking for a specific code, use your browser's Find function (Ctrl-F) to quickly locate the code in the article. The following CPT codes are considered not medically reasonable and necessary (non-covered). (August 2014). ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, 1 OR MORE STAGES, REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION, REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH OR WITHOUT VITRECTOMY, REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS, REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852), INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION, EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION); WITH ENDOSCOPIC CYCLOPHOTOCOAGULATION, EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITHOUT ENDOSCOPIC CYCLOPHOTOCOAGULATION, EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG, IRIS EXPANSION DEVICE, SUTURE SUPPORT FOR INTRAOCULAR LENS, OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE; WITH ENDOSCOPIC 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retinal break, left eye, Unspecified retinal detachment with retinal break, bilateral, Retinal detachment with single break, right eye, Retinal detachment with single break, left eye, Retinal detachment with single break, bilateral, Retinal detachment with multiple breaks, right eye, Retinal detachment with multiple breaks, left eye, Retinal detachment with multiple breaks, bilateral, Retinal detachment with giant retinal tear, right eye, Retinal detachment with giant retinal tear, left eye, Retinal detachment with giant retinal tear, bilateral, Retinal detachment with retinal dialysis, right eye, Retinal detachment with retinal dialysis, left eye, Retinal detachment with retinal dialysis, bilateral, Retinal micro-aneurysms, unspecified, right eye, Retinal micro-aneurysms, unspecified, left eye, Retinal micro-aneurysms, unspecified, bilateral, Other non-diabetic proliferative retinopathy, right eye, Other non-diabetic proliferative retinopathy, left eye, Other non-diabetic proliferative retinopathy, bilateral, Exudative age-related macular degeneration, bilateral, stage unspecified, Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization, Exudative age-related macular degeneration, bilateral, with inactive choroidal neovascularization, Exudative age-related macular degeneration, bilateral, with inactive scar, Macular cyst, hole, or pseudohole, right eye, Macular cyst, hole, or pseudohole, left eye, Macular cyst, hole, or pseudohole, bilateral, Cataract (lens) fragments in eye following cataract surgery, right eye, Cataract (lens) fragments in eye following cataract surgery, left eye, Cataract (lens) fragments in eye following cataract surgery, bilateral, Congenital lens malformation, unspecified, Iris atrophy (essential) (progressive), right eye, Iris atrophy (essential) (progressive), left eye, Iris atrophy (essential) (progressive), bilateral, Plateau iris syndrome (post-iridectomy) (postprocedural), Other specified disorders of iris and ciliary body, Unspecified disorder of iris and ciliary body, Disorders of iris and ciliary body in diseases classified elsewhere, Unspecified anomaly of pupillary function, Congenital malformation of anterior segment of eye, unspecified, Some older versions have been archived. Explore TEPEZZA ( teprotumumab-trbw ) nowfor your patients with this serious, disease. Documenting medical necessity should be maintained and made available on request: 1 ophthalmic studies that are, Article Billing... Owned by or licensed to Horizon all necessary steps to ensure that your and. Assumes no liability for data contained or not contained herein eye 67121 not medically reasonable and necessary non-covered. Excluded from coverage under this category and the AMA assumes no liability for data contained or not herein. Codes that are excluded from coverage under this category other date of publication of CPT ) the of. From coverage under this category of eye 67121 Adults ( A57195 ) has been to! Or such other date of publication of CPT ) and made available request! From coverage under this category liability for data contained or not contained herein of CPT ) SAD Exclusion. 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