How To Use CPT Code 66821

CPT 66821 involves the use of laser surgery to remove secondary membranous cataracts, improving a patient’s vision. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 66821.

1. What is CPT 66821?

CPT 66821 is a medical procedure code used to describe the removal of secondary membranous cataracts using laser surgery, such as YAG laser. This procedure is performed to improve a patient’s vision by eliminating the cloudiness caused by the cataract.

2. 66821 CPT code description

The official description of CPT code 66821 is: “Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or more stages)”.

3. Procedure

The CPT 66821 procedure involves the following steps:

1. The patient’s eye is anesthetized using eye drops to dilate the pupil.
2. The provider focuses a beam from a laser, such as a YAG laser, on the capsule of the eye.
3. The laser creates a hole in the capsule, removing the cloudiness and improving the patient’s vision.
4. Multiple tiny applications of the laser are used to create the hole.
5. Finally, the provider instills anti-inflammatory drops in the eye.

4. Qualifying circumstances

Patients eligible to receive CPT code 66821 services are those diagnosed with secondary membranous cataracts, which cause cloudiness in the posterior lens capsule and/or anterior hyaloid. These cataracts may develop after a previous cataract surgery or due to other eye conditions. The procedure is performed to improve the patient’s vision by removing the opacified lens capsule.

5. When to use CPT code 66821

It is appropriate to bill the 66821 CPT code when a patient with a secondary membranous cataract requires laser surgery to remove the opacified lens capsule and improve their vision. The code covers any number of subsequent YAG laser sessions within the 90-day global period.

6. Documentation requirements

To support a claim for CPT 66821, the following information should be documented:

• Patient’s medical history and diagnosis of secondary membranous cataract.
• Indication for the procedure, including the impact of the cataract on the patient’s vision.
• Details of the laser surgery, including the type of laser used and the number of stages performed.
• Postoperative care instructions and follow-up appointments.
• Any complications or adverse reactions experienced by the patient.

7. Billing guidelines

When billing for CPT code 66821, it is essential to follow the appropriate guidelines and rules. Ensure that the patient’s diagnosis supports the need for the procedure and that all necessary documentation is provided. Additionally, be aware of any payer-specific requirements or policies related to billing for this code. Remember that the code includes any number of subsequent YAG laser sessions within the 90-day global period.

8. Historical information

CPT 66821 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2009, with the previous descriptor being “Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (one or more stages)”.

9. Similar codes to CPT 66821

Five similar codes to CPT 66821 and how they differentiate are:

• CPT 66820: This code is used for the same procedure but performed using a Ziegler or Wheeler knife instead of a laser.
• CPT 66982: This code describes extracapsular cataract removal with insertion of an intraocular lens prosthesis, performed using complex techniques.
• CPT 66984: This code is for extracapsular cataract removal with insertion of an intraocular lens prosthesis, performed using standard techniques.
• CPT 66825: This code is for the repositioning of an intraocular lens prosthesis, performed with or without the removal of the original lens.
• CPT 66830: This code is for the removal of a lens material, performed using a pars plana approach.

10. Examples

Here are 10 detailed examples of CPT code 66821 procedures:

1. A patient with a secondary membranous cataract in the right eye undergoes YAG laser surgery to remove the opacified lens capsule and improve vision.
2. A patient with a secondary membranous cataract in the left eye undergoes YAG laser surgery, followed by two additional YAG laser sessions within the 90-day global period.
3. A patient with bilateral secondary membranous cataracts undergoes YAG laser surgery in both eyes, with the procedures performed on separate days.
4. A patient with a secondary membranous cataract in the right eye undergoes YAG laser surgery, followed by a second YAG laser session due to incomplete removal of the opacified lens capsule.
5. A patient with a secondary membranous cataract in the left eye undergoes YAG laser surgery, with the procedure performed in two stages due to the complexity of the cataract.
6. A patient with a secondary membranous cataract in the right eye undergoes YAG laser surgery, followed by a third YAG laser session due to the recurrence of the opacified lens capsule.
7. A patient with a secondary membranous cataract in the left eye undergoes YAG laser surgery, with the procedure performed in three stages due to the size of the cataract.
8. A patient with a secondary membranous cataract in the right eye undergoes YAG laser surgery, followed by a fourth YAG laser session due to the persistence of the opacified lens capsule.
9. A patient with a secondary membranous cataract in the left eye undergoes YAG laser surgery, with the procedure performed in four stages due to the density of the cataract.
10. A patient with a secondary membranous cataract in the right eye undergoes YAG laser surgery, followed by a fifth YAG laser session due to the reformation of the opacified lens capsule.