Complex Cataract Surgery Update

In April 2015, the Comparative Billing Reports (CBRs) sent to most ophthalmologists compared the surgeon’s use of complex cataract surgery CPT code 66982 to the Medicare normative data as established by CMS paid-claims from 2013. The reference benchmark indicated that 9% of all cataract surgeries (66984 + 66982) were filed and paid as complex. This wakeup call had many questioning the definition of complex cataract surgery and what qualifies a case as complex.

The CPT definition for 66982 states: Extracapsular cataract removal with insertion of 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 developmental stage.” Medicare Administrative Contractors (MACs) may provide additional detail in their local coverage decisions for cataract surgery. Not all MACs have published policies and not all MACs reference separately complex cataract surgery.

It has been commonplace for surgeons to use the complex code, 66982, when using Trypan Blue or Indocyanine Green (ICG) dye to stain the capsule when removing a dense/mature cataract. In March 2016, CPT Assistant published, “the additional work of instilling and removing Trypan Blue dye from the anterior segment though an additional surgical step does not reach the threshold of physician time, work, or intensity necessary to report the complex cataract code.

From a compliance perspective, first determine if your MAC publishes a policy on cataract surgery and if so, does it address the use of dye to support claim submission with 66982. In the absence of a payer or MAC policy, the CPT Assistant guidance should be followed.

As always, if you need assistance, Corcoran Consulting Group can help. Contact us for our new FAQ on complex cataract surgery. Visit our website or call us to learn more. You can access our new mobile application, Corcoran 24/7, via the links below. (800) 399-6565

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