Basics of procedure CPT code 66984

A cataract is a clouding of the lens in the eye which leads to a decrease in vision. Because the lens is normally transparent, the opaque cataract affects the lens’ ability to perform its focusing function which result in blurred vision, poor night vision, glare, and/or light sensitivity. In medical coding, their are different procedure codes for cataract removal. CPT code 66984, 66840, 66850, 66852, 66983, 66985, 66982, 66920 are mainly used for coding removal of cataract.

Cataracts are the most common cause of vision loss in people over age 40 and is the principal cause of blindness in the world. In coding also, we have CPT codes related to cataract which we will study today. 

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There are two main categories of cataract extractions, extracapsular and intracapsular. Method of cataract extraction helps in selecting the correct CPT Code.

An extracapsular extraction includes the removal of the lens material while leaving the posterior capsule intact. The extracapsular removal of lens material is reported with CPT code 66984, 66840-66852, 66940 and 66982.

The intracapsular extraction is performed rarely. It involves removal of entire lens including the capsule and are generally reported with CPT code 66920, 66930 and 66983.

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CPT code 66984, 66840, 66850, 66852, 66983, 66985, 66982, 66920 for Cataract Extraction

Cataract extraction is a surgery to remove a clouded lens (cataract) from the eye. Phacoemulsification and standard extracapsular cataract extraction (ECCE) are surgical methods that remove the cataract as well as the front portion on of the lens capsule (anterior capsule).

 Phacoemulsification (small-incision surgery)  is the most common type of cataract surgery. In this surgery, a circular opening is created on the lens surface (capsule). Sound waves (ultrasound) or laser is used to break the cataract into small pieces. The cataract and lens pieces are removed and then replaced with the intraocular lens implant (IOL). Below are the different CPT codes used for Cataract surgery.

66840  Removal of lens material; aspiration technique, one or more stages

66850  phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration

66852        pars plana approach, with or without vitrectomy

66920        intracapsular

66930        intracapsular, for dislocated lens

66940        extracapsular (other than 66840, 66850, 66852)

66982        Extracapsular cataract removal with insertion of intraocular lens prosthesis (one 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 develop-mental stage

66983        Intracapsular cataract extraction 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 (eg, irrigation and aspiration or phacoemulsification)

66985     Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal

While selecting the appropriate CPT codes for cataract extractions with IOL,  always indicate laterality of the operated eye using HCPCS Level II modifier “LT” or “RT,”.

For physician services, append modifier 51, Multiple Procedures, to the code for the secondary procedure.

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Sample report for Coding Cataract Removal CPT code 66984

PREOPERATIVE DIAGNOSIS:   Right eye visually significant cataract.

POSTOPERATIVE DIAGNOSIS:   Right eye nuclear sclerosis cataract.

ASSISTANT:   None.

ANESTHESIA:   Topical anesthesia.

COMPLICATIONS:   None.

PROCEDURE PERFORMED:  

Phacoemulsification cataract extraction with intraocular lens implant right eye.

LENS IMPLANT: SND1T5 14 diopter. Axis of placement is 5 degrees. Please note, patient prior to putting on a supine position, while in the sitting position under topical anesthesia 0, 90, and 180 degree axis were marked.

INDICATIONS FOR SURGERY:   This is a 50-year-old female with complaint of difficulty functioning with current vision in the right eye. Patient has  decreased visual acuity, has difficulty with daily activities and requests cataract extraction. The patient understands the risks of surgery including infection, bleeding, retinal detachments, chronic inflammation, macular edema, the need for additional surgery, loss of vision, loss of eye and blindness.

UNUSUAL FINDINGS: No unusual findings.

DESCRIPTION OF PROCEDURE:   After informed consent was obtained, patient was identified by attending surgeon and brought into the operating room. Patient was placed in a supine position. One drop of tetracaine topical anesthesia was placed in the eye. The eye was then prepped and draped in the usual sterile fashion. Patient received more anesthetic eye drops. A wire lid speculum was placed to open the eyelids and supersharp blades were used to create 2 paracentesis track incisions. Viscoelastic was injected into the anterior chamber. A 3.0 keratome was then used to create a clear corneal incision.

Prebent cystitome was used to create an anterior capsular flap. Utrata forceps was used to perform anterior curvilinear capsulorrhexis. BSS was injected for hydrodissection and hydrodelineation. Phacoemulsification was performed without any difficulty using the divide and conquer method. Irrigation aspiration was then performed to remove residual cortex. A SND1T5 14 diopter lens was then

inserted into the capsular bag after the anterior chamber was filled with viscoelastic. The lens was placed centrally without any difficulty and residual viscoelastic was removed using irrigation and aspiration. The wound was checked and found to be completely watertight. Subconjunctival injection of antibiotic and dexamethasone was given after additional anesthetic drops were placed on the

eye. A collagen shield soaked in antibiotic was also placed on the eye. The patient’s right eye was then patched and a Fox shield was placed over the eye and the patient taken to the recovery room in good condition. Please note that throughout surgery, when direct visualization of the anterior chamber was not necessary, an opaque corneal cap was placed over the eye.

Patient was advised to rest and have no heavy physical activity and report any pain to MD.

CPT 66984-RT

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification)

ICD 10- H25.11

Age related nuclear cataract right eye

References

http://www.symbiosisrcm.com/how-to-bill-cataract-surgery-with-iol-implant/

https://www.aao.org/eyenet/article/icd-10-codes-cataract-family

https://www.eyeworld.org/article-complex-cataract-surgery-coding–a-refresher-course