What You Need To Know Now About Complex Cataract Surgery Claims

It’s been more than a year since cataract surgeons received a CBR comparing their own 66982 data national averages, but complex cataract surgery billing continues to be a hot topic among the compliance experts who spoke at the ASCRS/ASOA annual meeting.

According to CMS, 9% of all cataract surgeries performed nationwide are “complex” and billed as 66982, explains presenter Donna McCure, CCS-P, COE, CPMA of Corcoran Consulting Group. Yet McCure and co-presenter Alan Reider have heard about outliers, including one practice where as many as 42% of cataract surgeries were billed as “complex.”

If you see numbers like this, you may have a coding and billing problem in your practice or ASC, they warn. “If the number is 12% rather than 42%, I’d feel very differently,” says attorney Reider. Small deviations from the national average are no reason to panic.

M&A Tip: If your practice is looking to be acquired, “make sure that you know your house is in order when it comes to complex cataract surgery claims,” Reider says. And if your practice is merging with or acquiring another practice, it’s smart to look at 66982 during due diligence to make sure you’re not getting into a compliance disaster.

“There could be good reasons your practice’s percentage of complex cataract surgeries performed is above national averages,” McCure says. If you’re an outlier, the next step is to check the chart notes and op notes associated with 66982 claims.

4 Questions for 66982

If you can answer “yes” to any of these four question, you’re likely clear to bill 66982 with confidence, say Jennifer S Edgar, OCS, Sue J Vicchrilli COT OCS.

  1. Is it a miotic pupil that won’t dilate sufficiently—thus requiring special instruments?
  2. Does the IOL need additional support, such as a capsular tension ring or intraocular sutures?
  3. Is this a pediatrics case that includes IOL implantation?
  4. Is the cataract considered mature, requiring dye?

Dye Alone Does Not Make It a Complex Cataract Surgery

Some practices and ASCs mistakenly believe that using Trypan Blue or Indocyanine Green (ICG) dye to stain the capsule during dense/mature cataract removal makes the procedure complex and justifies 66982.

Unless your payer or MAC has a policy that says differently, you should follow CPT Assistant, which the Corcoran Consulting Group reports as saying “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.”

Check for Chart Note for Prospective Planning

Don’t report 66982 just because the ophthalmologist encountered a surgical complication, such as the need to perform a vitrectomy, Alice Marie Reybitz, RN, BA, CPC, COC, CPC-I, CCS-P tells Ophthalmology Coding Alert. A true complex cataract extraction is prospectively planned based on pre-existing conditions.

“Report 66982 only if the ophthalmologist knows preoperatively that the procedure is necessary and meets the requirements of the code descriptor,” Reybitz instructs. Documentation in the medical record prior to the surgery will support this decision.

Learn more about common cataract compliance risks here.

By Erin Masercola

Photo Credit: © James Allan

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