Coding, Classification and Reimbursement

Cataract Surgery using a Tension Ring

  • 1.  Cataract Surgery using a Tension Ring

    Posted 12-26-2018 07:40
    ​​Any suggestions for a CPT code for cataract surgery where the provider inserts a tension ring instead of a lens.  We came up with 66982 and 66984 and were not sure which it should be or if it should be another code altogether.  Procedure performed:  Cataract removal by phacoemulsification with Insertion of capsular tension ring.  Description of procedure:  A clear corneal incision was made temporally using a 2.4 mm keratome.  A separate paracentesis wound was made superiorly using a 15-degree blade.  We then placed viscoelastic into the anterior chamber.  A capsulorrhexis was performed with a cystotome and forceps.  Hydrodissection was performed.  The nucleus was phacoemulsified uneventfully finding it to be a moderate nucleus.  We then switched to irrigation and aspiration and removed cortical material.  The posterior capsule was intact.  There was a good red reflex.  We inflated the capsular bag with Viscoelastic.  The capsular tension ring was placed into the capsular bag using the injector.  Viscoelastic was removed using irrigation and aspiration.  Intraophthalmic Vancomycin 0.1 mL was given into the anterior chamber and 0.2 mL of the same Vancomycin was given subconjunctivally.  The ring was in excellent position with intact posterior capsule and good red reflex.  The wound was hydrated, then tested and found to be watertight.

    [Amy] [Distad,] [RHIT]
    [Revenue Assurance Analyst]

  • 2.  RE: Cataract Surgery using a Tension Ring

    Posted 12-27-2018 10:21
    CPT code 66982 is defined as Extracapsular cataract removal with insertion of an 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 support for intraocular lens, or primary posterior capsulorrhexis) or performed on
    patients in the amblyogenic development stage.  Use of a CTR during cataract surgery fits within this definition. Therefore, the procedure would be
    coded as 66982

    Carol Nickels, RHIA, CCS
    Coding and Documentation Review Consultant
    Kaiser Permanente - Regional Offices (Oakland, CA)

  • 3.  RE: Cataract Surgery using a Tension Ring

    Posted 12-28-2018 18:29
    I feel codes 66982 and 66984 would not be appropriate in this case since they describe a single-stage procedure where an intraocular lens (IOL) insertion is also performed.  I can't find a code that exactly describes your scenario in that a capsular tension ring (CTR) is implanted instead of an IOL.  Code 66850 describes cataract extraction without immediate lens insertion.  This might be your code.  Did the surgeon mention the rationale for inserting the tension ring in the H&P (or Op report)?  Since the CTR was left in place, I'm leaning towards assigning the unlisted code to capture this step.

    Cristina Co
    Facility Outpatient Coder

  • 4.  RE: Cataract Surgery using a Tension Ring

    Posted 12-29-2018 06:36
    The diagnosis is combined cataract. There is no mention of why they used the tension ring.

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