CPT^® CODING MADE EASY

Sample from the CD

Example: Differences in coding and reimbursement of physician and outpatient hospital services (APCs)

Procedures: 66820 -- 66821

Discission of secondary membraneous cataract (opacified posterior lens capsule and/or anterior hyaloid);

Terms Defined:

Anterior hyaloid – a membrane that covers the anterior outer surface of the vitreous body in the posterior cavity of the eye and is in immediate contact with the posterior lens capsule and other adjacent structures.

Discission – incision (cutting into).

Secondary membraneous cataract—includes various conditions that may develop after extracapsular cataract extraction. (In extracapsular cataract extraction, the major portion of the anterior wall of the lens capsule is removed along with the lens, leaving behind a small rim of anterior [front] lens capsule and the entire posterior [rear] lens capsule or wall.) Postoperatively, the posterior capsule may become opaque because of the presence of lens fibers left behind on the capsule, which appear as white bands or fibers. Also, months to years after the operation, cells on the surface of the capsule undergo an internal change and grow on the posterior capsule, forming an opaque substance on it. Membranes covering the pupil also may develop from other causes. In the pediatric patient, growth of secondary membrane is not uncommon when a primary posterior capsulorrhexis is not performed at the time of cataract extraction.

Process

Coding Note:

When required by a payer such as Medicare, report the appropriate laterality modifier, -LT (left) or -RT (right), to identify the operated eye. These modifiers are to be used when a given procedure is performed on only one side. Hence, they are used to report unilateral procedures.

The object of this procedure is to create an opening in the opaque posterior lens capsule, allowing the patient to see clearly once again.

Example A:

Stab incision technique (Zieglar or Wheeler knife): A small needle with a knife-blade-shaped tip is inserted into the edge of the cornea. It is advanced to the opposite edge of the membrane and then inserted into it. The needle knife is drawn back through the membrane (and, if the surgeon desires, through the anterior hyaloid membrane beneath it), cutting it open.

Physician Coding Notes:

	When the laser procedure described in Example B is performed with a Nd-YAG laser, it often is referred to as a "YAG laser posterior capsulotomy."
	The procedure in Example B may be accomplished in one or multiple stages. Report this code only once, whether one or more than one session is required to achieve the clinical result. The relative value assigned to this procedure includes multiple stages or sessions as stated in the procedure descriptor.

APC/Outpatient Coding Note:

· The procedure described in Example B may be reported for each date of service it is provided by the facility.

[ KEY POINT: Physicians can report this only once regardless of the number of sessions required to complete the procedure but APC/Outpatient hospital coding allows this code to be reported for each date of service it is provided. If hospital coders read the CPT code literally, they will not report this code for the subsequent sessions on the other days, losing approximately $290.00 each day.

AVOIDING THIS ERROR WITH THE PRECISION CODING INFORMATION IN CPT CODING MADE EASY COULD PAY FOR THIS PRODUCT WITH ONLY ONE CLAIM ! ]

Example B:

Laser surgery(eg, YAG laser) (one or more stages): This procedure may be performed using the slit-lamp microscope/laser system. Generally, the pupil of the eye to be treated is mildly dilated, but may not be if the surgeon determines that it is unnecessary. Before dilation, a test shot with the laser may be placed in the center of the pupil on the posterior capsule. This acts as a marker spot indicating that this is the point through which the patient’s actual line of vision passes. Next, with the patient properly positioned and seated at the slit-lamp microscope, a number of laser shots are aimed at the posterior capsule in order to rupture it in a specific manner. The goal is to create flaps of capsule that adhere to the outer periphery of it while leaving an adequate opening in the center for clear vision. For example, the first shot may be made at the 12 o’clock position, with subsequent shots forming a vertical opening from 12 o’clock to 6 o’clock. Then, succeeding shots may be placed across the capsule in roughly a 3 o’clock to 9 o’clock direction. Multiple sessions may be required to bring the opening to adequate size.

Notice: The CPT Coding Made Easy CD is no longer available to retail purchasers. The information about CPT Coding Made Easy on this site is for historical and reference purposes only.

CPT is a registered trademark of the American Medical Association.

CPT® CODING MADE EASY

Sample from the CD

CPT^® CODING MADE EASY