Wednesday, June 3, 2020

2020 Updates for Cataract Extraction Procedures

Past “Spotlight on CPT” presented information regarding the correct coding for cataract extractions.  With the January 1st updates to CPT, there are some revisions and additions that coding professionals should be aware of.  Let’s dive in.

Two existing cataract removal codes 66982 and 66984 have both undergone revision.  For both codes the change is the same and that is the addition of the phrase: without endoscopic cyclophotocoagulation.  Therefore, the first thing we need to know is what is endoscopic cyclophotocoaguation.  It is a laser procedure that is performed (after a cataract extraction) on the ciliary body in order to control glaucoma.  Here is a link to a very short animation of the procedure:

Before we move on, just a little detail on the ciliary body.  As an extension of the iris, the ciliary body is a circular structure and has three main functions.  The first is that it helps the eye maintain focus, also known as accommodation.  Next, it is a support for the zonules, which anchor the lens.  Finally, it produces and reabsorbs aqueous humor.  If too much aqueous humor is produced, it raises the intraocular pressure and can result in glaucoma.

Here is a visual to help identify the location of the ciliary body:


Here are the revised cataract extraction codes:

66982 – Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-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 developmental stage; without endoscopic cyclophotocoagulation

66984 – Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique, (eg, irrigation and aspiration or phacoemulsification; without endoscopic cyclophotocoagulation

As you might imagine, if we have the option to assign a code without the cyclophotocoagulation, then we probably have a code(s) that support with cyclophotocoagulation.  That’s precisely what we find with the following new CPT codes.

66987 – (sequenced after complex description code 66982) with endoscopic cyclophotocoagulation

66988 – (sequenced after normal description code 66984) with endoscopic cyclophotocoagulation

Now, light has been shed on updates to cataract extractions for 2020.

About the Author
Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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