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Don’t Overcode Dropless Cataract Surgery

July 31, 2015:

Coders must be careful when reporting a recently developed approach to cataract surgery that involves the injection of compounded medications during the procedure. Some may be tempted to code the injections in addition to the procedure, but this runs against Medicare’s and many other payers’ coding guidelines.

Unlike traditional cataract surgery, the “dropless” procedure involves the physician’s injection of antibiotics and steroids during the surgery, lessening and sometimes eliminating the need for postoperative medicated eye drops. The steroid triamcinolone compounded with the antibiotic moxifloxacin and sometimes vancomycin is administered via cannula placed between the intraocular lens and posterior capsule, or via intravitreal injection.

The steroid-antibiotic combination helps to prevent inflammation and cystoid macular edema (CME) after surgery. As CME, the development of areas of cyst-like fluid in the macula and swelling of the retina, is the most common cause of decreased visual acuity after cataract surgery, any way to decrease the incidence of this complication after cataract surgery is a boon. Precluding the need for postsurgical medications also means fewer out-of-pocket costs for patients and can eliminate medication compliance issues.

When it comes to coding cataract surgery with intraoperative administration of the steroid-antibiotic compound, some report the cataract procedure (codes 66982–66984) as well as code 67028 Intravitreal injection of a pharmacological agent. Such coding will most likely trigger a claim denial, however.

Medicare and many other payers consider the medication injections integral to the surgery itself and therefore not separately reportable by the facility or physician. For instance, Medicare administrative contractor Noridian Healthcare Solutions states that “it is inappropriate to include such services when performed as a separately itemized part of a ‘package’ related to the insertion of a premium intraocular lens.” Noridian does cite one exception: when the surgery is performed on one eye and the injection is performed on the other. In that rare case, the cataract surgery code and the injection code would require modifier RT (right side) or LT (left side).

It would be appropriate to determine the guidelines for your specific payers regarding this procedure.


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