february 2010

OPHTHALMOLOGY

Ask a fellow coder and they will probably tell you that cataract extraction procedures are easy to code when it’s performed as a standalone procedure, but does everyone really understand the terminology used in the operative report? Let’s start with the crystalline lens, this is the natural lens that everyone has in their eye and not a type of IOL. The lens consists of three components – the capsule, cortex, and nucleus. During extracapsular cataract extraction the lens capsule is incised and usually a phacoemulsification technique is employed to remove the cortex and nucleus leaving the “capsular bag” in place. The IOL is then placed into the capsular bag. If at a later time this lens capsule becomes cloudy that would signal that the patient has developed capsular opacification or secondary cataract.

The CPT book lists two types of extraction procedures. As previously described there is an “extracapsular” extraction where the cortex and nucleus are removed leaving the capsule in place. There is also the less seldom used technique of “intracapsular” extraction wherein the entire lens is completely removed in one piece.

Are there other procedures that can be reported with a cataract extraction? YES. Even though a vitrectomy bundles per CCI edits there are specific instructions in the chapter guidelines that state, “ If an iridectomy is performed in order to complete a cataract extraction, it is an integral part of the procedure and is not separately reportable. Similarly, the minimal vitreous loss occurring during routine cataract extraction does not represent a vitrectomy and is not separately reportable. If an iridectomy or vitrectomy that is separate and distinct from the cataract extraction is performed for an unrelated reason at the same patient encounter, the iridectomy and/or vitrectomy may be reported separately with an NCCI-associated modifier.