2020 Updates for Cataract Extraction Procedures

Past “Spotlight on CPT” presented information regarding the correct coding for cataract extractions.  With the January 1^st 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: https://www.tysoneye.com/glaucoma-cape-coral/endoscopic-cyclophotocoagulation/

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:

Source: https://www.charllaas.com/the-eye/

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.

OHIMA Membership Benefits 101: Member Resources & Discounts

by Donna Edmondson, BS, RHIA & Jenny Evans, MSHI, RHIA, CCS

Each life has been affected by this pandemic and now, more than ever, we need to feel this sense of community.

Did you know that as a member of OHIMA and AHIMA, you are entitled to the following benefits?

• You automatically receive a State Association Membership at no extra cost when you become an AHIMA member

• Access to OHIMA website  www.ohima.org

• On the website you have access to:
• Mission and Vision Statement of OHIMA 
• Events and Education 
• Member-only resources such as scholarship opportunities 
• HIM related blog and other relevant HIM resources 
• HIM Career Link 
• Links to Ohio Regional Associations

• What does a membership get you? 
• Access to 4 free CEUs just by renewing your membership
• Discounts on products and seminars for both OHIMA and AHIMA
• Students and New members have a discounted membership fee
• Access to Engage Communities, HIM Library, and current responses to global HIM topics
• Career Assist and HIM Career Map

• Eligible for a new graduate or established professional scholarship
• Network with other HIM professionals and continue life-long learning

OHIMA and AHIMA are here for you and continuing to improve Health Information Management!

Get involved today! Complete the Volunteer Form on the Call for Volunteers page by 5/31/20!

About the Authors

Donna Edmondson, BS, RHIA is the Director of Government Audits & HIM at UC Health-West Chester Hospital. Jenny Evans, MSHI, RHIA, CCS is Instructor and Clinical Coordinator for the Master of Science Health Informatics Program at The University of Findlay. Both serve as Project Leaders for the Membership Engagement strategy on the OHIMA FY19-20 Board of Directors. 

Privacy and Security Considerations for LGBTQ Patient

by Alonzo Blackwell, RHIA


For years, the US’s LGBTQ community has raised concerns about the privacy and security of sensitive personal identifying data collected throughout their healthcare visits. There are laws that address privacy and security in some fashion for this patient population. The laws provide a floor for managing protected health information (PHI) and personally identifiable information. Collection of this information is no different than when healthcare organizations started collecting HIV information. Consideration can be given to additional protections if it is determined that operationally, it is appropriate within the individual healthcare organization.

The HIPAA Privacy Rule states:

• SO/GI or history of transition-related procedures may constitute PHI. 
• Hospitals and other covered entities should provide training to physicians, employees and contractors to ensure compliance. 
• A covered entity must have in place and apply appropriate sanctions against members of its workforce who violate the entity’s policies and procedures and the HIPAA Privacy Rule. 
• Hospitals may use or disclose a patient’s PHI to a family member, other relative, close friend or any other person the patient identifies. 
• The law respects the patient’s wishes on matters of privacy and confidentiality.
  

The Office of Civil Rights (OCR) has explicitly stated that this prohibition extends to claims of discrimination based on gender identity. It prohibits the denial of healthcare or health coverage based on an individual’s sex, including discrimination based on pregnancy, gender identity and sex stereotyping. Section 1557 of the Patient Protection and Affordable Care Act of 2010 builds on prior federal civil rights laws to prohibit sex discrimination in health care. The final rule also requires covered health programs and activities to treat individuals consistent with their gender identity.

The Joint Commission standard R1.01.01.01, EP 29 also protects LBGTQ individuals. EP 29 prohibits hospital discrimination based on age, race ethnicity, religion, culture, language, physical or mental disability, socioeconomic status, sex sexual orientation and gender identity or expression.

In 2016, Federal Rule 45 CFR 170 under the HITECH  Act provided the following as a guideline to “improve health care quality, safety and efficiency through the promotion of health IT and electronic health information exchange.” It particularly refers to “reducing health disparities” by:

• Ensuring that each patient’s health information is secure and protected, in accordance with applicable law 
• Improving health care quality, reducing medical errors, reducing health disparities and advancing the delivery of patient-centered medical care. 
• Reducing healthcare costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incomplete information 
• Providing appropriate information to help guide medical decisions at the time and place of care.
  

Some organizations have discussed placing additional security on patient records that contain sensitive sexual orientation and gender identity-similar to “break the glass” technology or protections that are currently used with behavioral health records and substance use disorder records today. There are no clear industry guidelines or standards.

Another area of concern is that some are calling “special security access” for the LGBTQ population. For example, a patient has undergone reassignment surgery. Questions have arisen about going to the extent of masking or placing increased EHR security on prereassignment surgery or clinical records such as Male to Female (MTF) or Female to Male (FTM). This practice is not recommended as it would change the clinical picture of the patient and would not allow the caregiver to have a comprehensive, historical patient story. Many questions remain unanswered and HIM professionals , in particular are being challenged to answer these questions as the need for privacy is balanced with the expectations for high quality care provision and data usage and reporting.

Some of the larger EHR vendors have been working on the creation of LGBTQ modules where patient identity and preferred name can be captured and displayed in the patient header.

In summary, special consideration should be given for addressing SO/GI data in the following areas privacy/security, population health, physician engagement and patient/consumer engagement. HIM professionals have a unique opportunity to assist in the design , implementation and execution of technology and operational processes that ensure LGBTQ patients can receive quality, inclusive and safe health care. HIM can also ensure data is sound and available to foster population health that is managed safely, securely and privately-- an expectation of all healthcare consumers.
 

About the Author

Alonzo Blackwell, RHIA is an Area Manager at MRO. He serves as a 1st-year Director on the OHIMA FY 2019-20 Board of Directors, overseeing the Privacy & Security strategy and Student & New Graduate Committee.