What You Need to Know Now About Complex Cataract Surgery Claims

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• What You Need to Know Now About Complex Cataract
  Surgery Claims
• Its been more than a year since cataract
  surgeons received a 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, Id feel very differently, says attorney
  Reider. Small deviations from the national
  average are no reason to panic.
• MA 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, its smart to look at 66982 during due
  diligence to make sure youre not getting into a
  compliance disaster.
• There could be good reasons your practices
  percentage of complex cataract surgeries
  performed is above national averages,
• McClure says. If youre 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
  questions, youre likely clear to bill 66982 with
  confidence, say Jennifer S Edgar, OCS, Sue J
  Vicchrilli COT OCS.Is it a miotic pupil that
  wont dilate sufficientlythus requiring special
  instruments?

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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 Dont 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.