CPT copyright 2009 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
Lolita M. Jones, RHIA, CCS, is a consultant specializing in ASC and hospital outpatient coding, billing, reimbursement and operations. The following question is in response to section seven of "8 Common Coding Errors for 7 ASC Specialties."
Q: I have a question about the coding for ophthalmology. I am unaware of sphincterotomies during a complex cataract extraction. What is a complex cataract repair using the code 66982? The ASC receives the same reimbursement as the code 66984, even though the ASC is using more supplies for the 66982.
Lolita Jones: Here are the official American Medical Association (AMA) CPT coding guidelines:
Source: Nov. 2003 and Sept. 2009 CPT Assistant newsletters, AMA:
Cataract extraction in glaucoma patients can require complex techniques or maneuvers to accomplish cataract extraction and/or intraocular lens (IOL) insertion. For example, chronic administration of pupillary constriction medication (miotics) for glaucoma often reduces the pupillary response to mydriatics (drugs that cause pupillary dilation) administered before the extraction procedure. To overcome this situation and allow visualization of an access to the lens, the physician may need to use an iris expansion device, such as iris retractors (flexible retractors hooked onto the pupillary edge of the iris), to enlarge and maintain the pupillary opening during lens extraction and IOL insertion. In other situations, the physician may be able to accomplish dilation by performing multiple sphincterotomies in the iris (tiny, radial incisions in the sphincter muscle of the iris). Code 66982 is selected when extracapsular cataract extraction (ECCE) involves these or any one of the other techniques described in that code. NOTE: Dilation of the iris by manually stretching it with a hook inserted through the same incision does not justify the use of code 66982.
Source: Sept. 2009 CPT Assistant newsletter, AMA:
The use of a special pupil-stretching device such as a Beehler pupil stretcher or other such similar devices does justify use of this code.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.