Did you perform an extracapsular cataract extraction via ultrasonic waves and end the procedure with intraocular lens (IOL) insertion? Use CPT code 66984 to bill for the procedure! A cataract, the clouding of the natural lens, is a common age-related eye condition. In fact, it is so common that more than half of all people aged 80 or above in the U.S. either have cataracts or have undergone an intervention to get rid of them.
As an ophthalmologist, this procedure may be a routine for your practice. But, do you also make routine mistakes while coding it due to complicated requirements and confusion? Today, let’s simplify 66984, a CPT code referring to extracapsular cataract extraction with lens insertion.
CPT Code 66984 Description
Grouped under the intraocular lens procedural codes, CPT code 66984 is popular in ophthalmology. As we briefly mentioned in the intro, this code refers to a surgical procedure, Extracapsular Cataract Extraction (ECCE), for removing the cloudy lens from the eye and replacing it with an artificial one – IOL.
In simple terms, CPT code 66984 represents a cataract removal surgery via manual or mechanical techniques, including aspiration or phacoemulsification (a modern surgical method for removing cataracts).
Phacoemulsification is the most frequently used method. Healthcare providers, usually ophthalmologists, start this procedure by making a small incision of 2 to 3 mm. They then use ultrasonic waves to break up the clouded lens into tiny fragments and remove them via suction. After that, they insert an intraocular lens to restore vision.
To summarize the description, CPT code 66984 covers two things:
- Removing the cataractous lens via an ultrasonic probe
- Inserting the intraocular lens
Scenarios Where CPT Code 66984 is Applicable
So, when can you apply CPT code 66984? Here are three examples:
Removing Cataract Acquired after a Trauma
Did you know cataracts are the most common reason for vision loss in the U.S.? This eye condition affects over 20.5 million Americans aged 40 and above. However, young people can also have either a congenital or acquired cloudy lens due to several reasons, including traumatic blows or eye diseases.
Let’s come up with a real-life scenario based on this! Suppose a 17-year-old experiences a gradually decreasing vision several months after getting into a fist fight. He visits an ophthalmologist and describes his other symptoms, such as seeing spots in his vision and blurry images. Upon further questioning, the patient reveals that he got punched in his right eye during a fight.
Suspecting traumatic cataract, the physician conducts a comprehensive exam to assess the severity. After confirming the diagnosis, he then performs phacoemulsification to restore the patient’s vision. In simple terms, he removes the cataractous lens using ultrasonic waves and then implants an IOL. His billing team then uses CPT code 66984 to report the procedure.
Removing Age-Related Cataracts
Statistically, 67.7 years is the average age at which patients have their first cataract removal surgery. Assume a 68-year-old woman arrives at an ophthalmology clinic after experiencing drastic changes in her vision. She has two primary concerns: being unable to read or drive at night.
The ophthalmologist conducts a detailed eye examination and notices a cloudy lens in her right eye. He communicates this information and, after acquiring the patient’s consent, performs a cataract removal surgery using an ultrasonic probe.
He replaces the clouded lens with an appropriate intraocular lens to improve her vision. The provider then uses CPT code 66984 to bill for this procedure.
Removing Toxic Cataract (Clouding of the Lens due to Certain Drugs)
Did you know that cataracts can also develop due to long-term use of certain drugs, like corticosteroids and phenothiazines? These medications can cause changes in the patient’s eye lens, leading to impaired vision.
So, for our final example, let’s consider a 25-year-old man with severe asthma developing a toxic cataract in his left eye. The main reason? Taking systemic corticosteroids for many years. After experiencing light sensitivity and blurred vision for some time, he visits a hospital on his family’s insistence.
The ophthalmologist takes his history and notices the long-term exposure to corticosteroids. The physician uses a mechanically assisted extracapsular technique (phacoemulsification) to remove his cloudy lens, replacing it with an IOL. He then files a claim for this service using CPT code 66984.
Applicable Modifiers for CPT Code 66984
Want to emphasize certain details, such as the specific eye in which you have performed the cataract removal surgery? Use the following modifiers with CPT code 66984:
Modifier LT
If you have removed the left cloud lens and replaced it with an IOL, use modifier LT with CPT code 66984.
Modifier RT
On the other hand, append modifier RT to CPT code 66984 if you performed the procedure on the right eye.
Modifier 50
For reporting bilateral cataract removal procedures performed within the same session, apply modifier 50 to CPT code 66984.
Modifier 53
Cataract removal surgery via phacoemulsification is usually safe. However, it has some risks. These include less severe health hazards, such as inflammation or infection, and severe consequences, like retinal detachment.
So, if you discontinued the procedure after administering topical or general anesthesia due to one of these potential risks, use modifier 53 with CPT code 66984.
CPT Code 66984 – Billing & Reimbursement Guidelines
Understood the correct application of CPT code 66984? Now, it’s time to understand the billing and reimbursement rules.
Use 66984 for Cataract Removal Surgery with IOL Insertion
There are several cataract removal techniques, and equally, the same number of associated codes. Don’t pick these codes randomly if you want to avoid denials! Remember, CPT code 66984 covers a 1-stage cataract removal procedure.
In simple terms? It refers to a surgical process where healthcare providers remove and replace a cloudy lens with an intraocular lens within the same session. Hence, use CPT code 66984 only when you have used a manual or mechanical technique, such as aspiration or phacoemulsification, to restore a patient’s vision.
Understand the Bundling Requirements
Since CPT code 66984 refers to a major surgery, it has a global period of 90 days. You know what that means? The following services are included within this code:
- Pre-operative visits (1 day before the operation)
- Cataract removal surgery
- Intraocular lens insertion
- Post-operative care services (pain management or any other related service for up to 90 days)
In short, CPT 66984 covers all these components. Avoid billing them separately to reduce denials.
Justify the Medical Necessity for Cataract Removal Surgery
Documentation is unavoidable! Most payers only consider cataract removal with IOL insertion (CPT code 66984) if it is medically necessary. Therefore, your documentation must indicate the essential reason for performing this procedure: to restore a patient’s vision.
Make sure to mention how the patient is unable to carry out most Activities of Daily Living (ADLs), such as reading, driving, or watching TV. Additionally, your records must include the patient’s best-corrected visual acuity (BCVA), the sharpest vision a person can achieve with glasses or lenses.
For cataract removal surgery, the BCVA should be 20/50 or worse. In short, your records must include:
- Primary concern (blurry or gradually decreasing vision)
- BCVA results
- Impact on ADLs
- Test results (consensual light testing or glare testing)
- Operative report
- Type of lens inserted
Use Appropriate Modifiers with 66984
Use LT, RT, or modifier 50 with CPT code 66984 to specify where you have performed the procedure. You can also use other modifiers to communicate unusual circumstances.
Pay Attention to Payer Coverage Requirements
As always, file claims according to payer-specific rules. Pay attention to their specific coverage requirements, including Medicare’s Local Coverage Determinations (LCDs), for CPT code 66984.
Summary
Too much information? Let us quickly summarize everything! CPT code 66984 refers to the surgical removal of a cataract with IOL insertion. This code covers several manual or mechanical methods, including the most frequently used phacoemulsification. We broke this code down in plain language so you can understand its correct application.
Although we highlighted all the essential details, including the best billing tips, you can still outsource coding. Explore expert ophthalmology billing services for better results and improve your coding accuracy with our tips for timely payments.
