Description of CPT code 66821

The patient initially had extracapsular cataract surgery in which the posterior shell of the lens was not removed from the eye. But the capsule and/or the membrane adjacent to it (the anterior hyaloid) has since become opaque and must be destroyed in this new surgery. After a topical anesthetic is applied to the eye, the pupil is dilated. A number of YAG laser shots are focused to a point on the capsule, cutting it. Bursts from the YAG open a flap in the capsule, resulting in immediate improvement in vision. Multiple sessions may be needed to create an adequate opening in the lens capsule.

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A secondary membranous cataract, also referred to as an after-cataract, is treated by discission using a stab incision technique (Ziegler or Wheeler knife). This procedure is performed when the remaining posterior portion of the lens capsule or the anterior hyaloid membrane that covers the anterior outer surface of the vitreous body in the posterior cavity of the eye becomes opacified or cloudy and impairs vision. This condition is sometimes referred to as posterior capsule opacification (PCO).

A small surgical needle with a knife-like tip is inserted through the edge of the cornea and advanced into the posterior lens capsule and/or the anterior hyaloid membrane beneath the lens capsule. The posterior lens capsule and/or anterior hyaloid are incised using the small needle-knife and the secondary membranous cataract is opened providing an area of clear vision.

In CPT code 66821, the secondary membranous cataract is opened by laser surgery in one or more stages. This procedure may also be referred to as a YAG laser capsulotomy. Eye drops may be used to dilate the pupil. A test shot is placed with the laser to mark the center of the pupil on the posterior capsule. Using a slit lamp microscope, the laser is aimed at the posterior capsule and fired in a pattern that opens the center to provide an area of clear vision. More than one session may be required to create an adequate sized opening in the center of the posterior lens.

66821 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR
LENS CAPSULE AND/OR ANTERIOR HYALOID); LASER SURGERY (EG, YAG LASER)
(1 OR MORE STAGES)

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Coding Guidelines for CPT code 66821

Report procedure code 66821 with the -50 modifier if the procedure is done bilaterally.

Report procedure code 66821 with a -LT or -RT modifier if performed on one eye only.

Report procedure code 66821 with a –78 modifier if performed within 90 days of cataract surgery.

When a series of procedures is planned for the removal of a posterior dense fibrotic capsule, it will be covered as a single procedure.

The documentation should indicate that the patient had a previous cataract extraction, usually more than three months ago to support this code. The provider must note that he or she is using a laser to perform the capsulotomies. If the scar issues need to be treated in more than one encounter, the provider should not have additional billing because this code represents one or more sessions.

RVU and Fees for CPT code 66821

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ICD-10-CM codes support medical necessity for CPT code 66821

D23.11 Other benign neoplasm of skin of right eyelid, including canthus
D23.12 Other benign neoplasm of skin of left eyelid, including canthus
D31.31 Benign neoplasm of right choroid
D31.32 Benign neoplasm of left choroid
E10.311 Type 1 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E10.319 Type 1 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E10.3593 Type 1 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
E10.36 Type 1 diabetes mellitus with diabetic cataract
E10.39 Type 1 diabetes mellitus with other diabetic ophthalmic complication
E10.65 Type 1 diabetes mellitus with hyperglycemia
E11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema
E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema
E11.3212 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, left eye
E11.3213 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, bilateral
E11.3291 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, right eye
E11.3292 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, left eye
E11.3293 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, bilateral
E11.3299 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy without macular edema, unspecified eye
E11.3313 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema, bilateral
E11.3393 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy without macular edema, bilateral
E11.3511 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye
E11.3513 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular edema, bilateral
E11.3591 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, right eye
E11.3592 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, left eye
E11.3593 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, bilateral
E11.3599 Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye
E11.36 Type 2 diabetes mellitus with diabetic cataract
E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication
E11.9 Type 2 diabetes mellitus without complications
G24.5 Blepharospasm
H01.001 Unspecified blepharitis right upper eyelid
H01.003 Unspecified blepharitis right eye, unspecified eyelid
H01.004 Unspecified blepharitis left upper eyelid
H01.009 Unspecified blepharitis unspecified eye, unspecified eyelid
H02.401 Unspecified ptosis of right eyelid
H02.403 Unspecified ptosis of bilateral eyelids
H02.831 Dermatochalasis of right upper eyelid
H02.833 Dermatochalasis of right eye, unspecified eyelid
H02.834 Dermatochalasis of left upper eyelid
H02.839 Dermatochalasis of unspecified eye, unspecified eyelid
H02.89 Other specified disorders of eyelid
H04.121 Dry eye syndrome of right lacrimal gland
H04.122 Dry eye syndrome of left lacrimal gland
H04.123 Dry eye syndrome of bilateral lacrimal glands
H04.129 Dry eye syndrome of unspecified lacrimal gland
H10.13 Acute atopic conjunctivitis, bilateral
H10.45 Other chronic allergic conjunctivitis
H11.001 Unspecified pterygium of right eye
H11.002 Unspecified pterygium of left eye
H11.153 Pinguecula, bilateral
H16.143 Punctate keratitis, bilateral
H16.223 Keratoconjunctivitis sicca, not specified as Sjögren’s, bilateral
H17.89 Other corneal scars and opacities
H17.9 Unspecified corneal scar and opacity
H18.51 Endothelial corneal dystrophy
H18.52 Epithelial (juvenile) corneal dystrophy
H18.59 Other hereditary corneal dystrophies
H20.00 Unspecified acute and subacute iridocyclitis
H20.9 Unspecified iridocyclitis
H21.41 Pupillary membranes, right eye
H21.42 Pupillary membranes, left eye
H21.541 Posterior synechiae (iris), right eye
H25.031 Anterior subcapsular polar age-related cataract, right eye
H25.032 Anterior subcapsular polar age-related cataract, left eye
H25.033 Anterior subcapsular polar age-related cataract, bilateral
H25.039 Anterior subcapsular polar age-related cataract, unspecified eye
H25.041 Posterior subcapsular polar age-related cataract, right eye
H25.042 Posterior subcapsular polar age-related cataract, left eye
H25.043 Posterior subcapsular polar age-related cataract, bilateral
H25.049 Posterior subcapsular polar age-related cataract, unspecified eye
H26.041 Anterior subcapsular polar infantile and juvenile cataract, right eye
H26.042 Anterior subcapsular polar infantile and juvenile cataract, left eye
H26.043 Anterior subcapsular polar infantile and juvenile cataract, bilateral
H26.049 Anterior subcapsular polar infantile and juvenile cataract, unspecified eye
H26.051 Posterior subcapsular polar infantile and juvenile cataract, right eye
H26.052 Posterior subcapsular polar infantile and juvenile cataract, left eye
H26.053 Posterior subcapsular polar infantile and juvenile cataract, bilateral
H26.059 Posterior subcapsular polar infantile and juvenile cataract, unspecified eye
H26.40 Unspecified secondary cataract
H26.411 Soemmering’s ring, right eye
H26.412 Soemmering’s ring, left eye
H26.413 Soemmering’s ring, bilateral
H26.419 Soemmering’s ring, unspecified eye
H26.491 Other secondary cataract, right eye
H26.492 Other secondary cataract, left eye
H26.493 Other secondary cataract, bilateral
H26.499 Other secondary cataract, unspecified eye
H26.8 Other specified cataract
H26.9 Unspecified cataract
H27.8 Other specified disorders of lens
H31.011 Macula scars of posterior pole (postinflammatory) (post-traumatic), right eye
H31.012 Macula scars of posterior pole (postinflammatory) (post-traumatic), left eye
H33.001 Unspecified retinal detachment with retinal break, right eye
H33.002 Unspecified retinal detachment with retinal break, left eye
H33.011 Retinal detachment with single break, right eye
H33.311 Horseshoe tear of retina without detachment, right eye
H34.8312 Tributary (branch) retinal vein occlusion, right eye, stable
H34.8320 Tributary (branch) retinal vein occlusion, left eye, with macular edema
H35.033 Hypertensive retinopathy, bilateral
H35.30 Unspecified macular degeneration
H35.31 Nonexudative age-related macular degeneration
H35.3110 Nonexudative age-related macular degeneration, right eye, stage unspecified
H35.3111 Nonexudative age-related macular degeneration, right eye, early dry stage
H35.3112 Nonexudative age-related macular degeneration, right eye, intermediate dry stage
H35.3121 Nonexudative age-related macular degeneration, left eye, early dry stage
H35.3122 Nonexudative age-related macular degeneration, left eye, intermediate dry stage
H35.3130 Nonexudative age-related macular degeneration, bilateral, stage unspecified
H35.3131 Nonexudative age-related macular degeneration, bilateral, early dry stage
H35.3132 Nonexudative age-related macular degeneration, bilateral, intermediate dry stage
H35.3133 Nonexudative age-related macular degeneration, bilateral, advanced atrophic without subfoveal involvement
H35.3134 Nonexudative age-related macular degeneration, bilateral, advanced atrophic with subfoveal involvement
H35.3190 Nonexudative age-related macular degeneration, unspecified eye, stage unspecified
H35.3211 Exudative age-related macular degeneration, right eye, with active choroidal neovascularization
H35.3212 Exudative age-related macular degeneration, right eye, with inactive choroidal neovascularization
H35.3221 Exudative age-related macular degeneration, left eye, with active choroidal neovascularization
H35.3230 Exudative age-related macular degeneration, bilateral, stage unspecified
H35.3231 Exudative age-related macular degeneration, bilateral, with active choroidal neovascularization
H35.3232 Exudative age-related macular degeneration, bilateral, with inactive choroidal neovascularization
H35.341 Macular cyst, hole, or pseudohole, right eye
H35.342 Macular cyst, hole, or pseudohole, left eye
H35.343 Macular cyst, hole, or pseudohole, bilateral
H35.351 Cystoid macular degeneration, right eye
H35.352 Cystoid macular degeneration, left eye
H35.361 Drusen (degenerative) of macula, right eye
H35.362 Drusen (degenerative) of macula, left eye
H35.363 Drusen (degenerative) of macula, bilateral
H35.371 Puckering of macula, right eye
H35.372 Puckering of macula, left eye
H35.373 Puckering of macula, bilateral
H35.413 Lattice degeneration of retina, bilateral
H35.52 Pigmentary retinal dystrophy
H35.81 Retinal edema
H35.89 Other specified retinal disorders
H40.001 Preglaucoma, unspecified, right eye
H40.002 Preglaucoma, unspecified, left eye
H40.003 Preglaucoma, unspecified, bilateral
H40.009 Preglaucoma, unspecified, unspecified eye
H40.011 Open angle with borderline findings, low risk, right eye
H40.012 Open angle with borderline findings, low risk, left eye
H40.013 Open angle with borderline findings, low risk, bilateral
H40.023 Open angle with borderline findings, high risk, bilateral
H40.031 Anatomical narrow angle, right eye
H40.032 Anatomical narrow angle, left eye
H40.033 Anatomical narrow angle, bilateral
H40.051 Ocular hypertension, right eye
H40.052 Ocular hypertension, left eye
H40.053 Ocular hypertension, bilateral
H40.1111 Primary open-angle glaucoma, right eye, mild stage
H40.1112 Primary open-angle glaucoma, right eye, moderate stage
H40.1113 Primary open-angle glaucoma, right eye, severe stage
H40.1121 Primary open-angle glaucoma, left eye, mild stage
H40.1122 Primary open-angle glaucoma, left eye, moderate stage
H40.1123 Primary open-angle glaucoma, left eye, severe stage
H40.1130 Primary open-angle glaucoma, bilateral, stage unspecified
H40.1131 Primary open-angle glaucoma, bilateral, mild stage
H40.1132 Primary open-angle glaucoma, bilateral, moderate stage
H40.1133 Primary open-angle glaucoma, bilateral, severe stage
H40.1134 Primary open-angle glaucoma, bilateral, indeterminate stage
H40.1190 Primary open-angle glaucoma, unspecified eye, stage unspecified
H40.1231 Low-tension glaucoma, bilateral, mild stage
H40.1232 Low-tension glaucoma, bilateral, moderate stage
H40.211 Acute angle-closure glaucoma, right eye
H40.2233 Chronic angle-closure glaucoma, bilateral, severe stage
H40.831 Aqueous misdirection, right eye
H40.89 Other specified glaucoma
H40.9 Unspecified glaucoma
H43.02 Vitreous prolapse, left eye
H43.11 Vitreous hemorrhage, right eye
H43.12 Vitreous hemorrhage, left eye
H43.311 Vitreous membranes and strands, right eye
H43.312 Vitreous membranes and strands, left eye
H43.391 Other vitreous opacities, right eye
H43.392 Other vitreous opacities, left eye
H43.393 Other vitreous opacities, bilateral
H43.811 Vitreous degeneration, right eye
H43.812 Vitreous degeneration, left eye
H43.813 Vitreous degeneration, bilateral
H43.819 Vitreous degeneration, unspecified eye
H44.23 Degenerative myopia, bilateral
H47.233 Glaucomatous optic atrophy, bilateral
H52.13 Myopia, bilateral
H52.203 Unspecified astigmatism, bilateral
H52.213 Irregular astigmatism, bilateral
H52.223 Regular astigmatism, bilateral
H52.4 Presbyopia
H52.7 Unspecified disorder of refraction
H53.001 Unspecified amblyopia, right eye
H53.002 Unspecified amblyopia, left eye
H53.10 Unspecified subjective visual disturbances
H53.19 Other subjective visual disturbances
H53.2 Diplopia
H53.40 Unspecified visual field defects
H53.71 Glare sensitivity
H53.8 Other visual disturbances
H53.9 Unspecified visual disturbance
H54.7 Unspecified visual loss
H57.12 Ocular pain, left eye
H57.8 Other specified disorders of eye and adnexa
H59.021 Cataract (lens) fragments in eye following cataract surgery, right eye
H59.022 Cataract (lens) fragments in eye following cataract surgery, left eye
H59.031 Cystoid macular edema following cataract surgery, right eye
H59.091 Other disorders of the right eye following cataract surgery
H59.092 Other disorders of the left eye following cataract surgery
T85.21XA Breakdown (mechanical) of intraocular lens, initial encounter
T85.22XA Displacement of intraocular lens, initial encounter
T85.29XA Other mechanical complication of intraocular lens, initial encounter
Z48.810 Encounter for surgical aftercare following surgery on the sense organs
Z79.4 Long term (current) use of insulin
Z79.84 Long term (current) use of oral hypoglycemic drugs
Z86.69 Personal history of other diseases of the nervous system and sense organs
Z87.891 Personal history of nicotine dependence
Z94.7 Corneal transplant status
Z96.1 Presence of intraocular lens
Z98.41 Cataract extraction status, right eye
Z98.42 Cataract extraction status, left eye
Z98.49 Cataract extraction status, unspecified eye
Z98.83 Filtering (vitreous) bleb after glaucoma surgery status
Z98.890 Other specified postprocedural states