CODING Q&A

Coding Vitreous/Retina Associated With Lens Procedures

Information Provided By Riva Lee Asbell

Surgeons most often seek coding help for retinal detachment repair or vitrectomy with associated cataract and intraocular/crystalline lens surgery performed at the same session. Obstacles encountered for correct coding include the National Correct Coding Initiative bundles, ambiguity of code selection and difficulty in determining the correct modifiers. Let's look at some queries from clients and work our way through them.

Q. I have a coding question about a procedure performed in our ASC. Is a posterior capsulotomy separately billable when performed at the same session as the retinal detachment repair surgery (67108) when an aphakic patient has secondary lens opacification? The opening in the capsule was made with the tip of the vitrector.

A. The capsulotomy would be included with 67108 (Repair of retinal detachment by vitrectomy, including lensectomy…).

Q. Could you please advise me how to code the following? Nonmagnetic intraocular foreign body removal using pars plana lensectomy vitrectomy + prophylactic endolaser for retinal tears + insertion of anterior chamber IOL+ internal limiting membrane peeling for concurrent macular hole.

A. Without operative notes, this is difficult — but I would suggest 67042 (Vitrectomy with removal of internal limiting membrane) + 65265 (Removal of foreign body) + 66984 (Phaco with IOL insertion) — the rest of the codes are bundled or part of the larger procedure(s).

Q. I wanted to ask you about coding this case. Diagnoses were cataract and macular hole. There was a zonular dialysis during the phaco portion, so I switched to pars plana lensectomy using the fragmatome and proceeded to do PPV with ILM peel for macular hole, and finished with placing an AC IOL.

I coded: PPV with ILM peel 67042, phacofragmentation technique 66850, and insertion of secondary IOL 66985. Does this sound right? Is implantation of the lens bundled into phacofragmentation?

A. Yes, 66985 is bundled with 66850 and would require modifier 59. Since all procedures were performed in the same session, it might be easier to just do 67042 + 66984.

Q. I did the following case: pars plana vitrectomy with internal limiting membrane peel for macular hole with suturing of the subluxated posterior chamber intraocular lens (that was already present in the eye) to the iris. Which procedure code do you use in addition to 67042 (macular hole surgery) and which modifier?

A There is a choice: 66825 (repositioning of IOL requiring an incision) or 66682 (suture of iris, ciliary body…McCannel suture). Code 66825 pays higher and is a more accurate description of what was performed. Neither is bundled. No special modifier is needed except 51 if your insurer requires it, as long as you are not in the global period. If you are, then use modifier 79.

Q. Our retinal specialist proposes to do a pars plana vitrectomy with pars plana lensectomy for repair of retinal detachment. She will then insert an anterior chamber IOL. She indicates that this is a complicated cataract surgery as well. How do we code this to include all services? We can code for PPV, PPL, but not sure how to include the insertion of the AC IOL.

A. This question does not give sufficient information to be coded yet. Complicated is not complex — this applies to complex cataract extraction as it does to complex retinal detachment surgery.

If there are clinical conditions that would qualify the case as complex cataract extraction (eg, floppy iris syndrome, dislocated crystalline lens, synechiae, etc) then it could be coded as 66982 (complex cataract extraction with IOL insertion,) with proper documentation. If not, then one would use 66984 (cataract extraction with IOL insertion). Code the vitrectomy (67036) first if you use 66984; second for 66982. Because of the bundles, you need to apply modifier 59 after the second code. RP

All CPT codes are copyrighted 2012 by the American Medical Association.