How To Use CPT Code 66852

CPT 66852 describes the procedure for the removal of lens material through a pars plana approach, with or without vitrectomy. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 66852?

CPT 66852 can be used to describe the surgical procedure performed to remove lens material from the eye. This procedure is typically done to treat cataracts, which cause blurred vision. The provider makes an incision through the pars plana, a structure in the middle of the eye, and removes the lens material using a gauge cutter and aspiration. Vitreous humor, the gelatinous substance in the eye, may also be removed during the procedure.

2. Official Description

The official description of CPT code 66852 is: ‘Removal of lens material; pars plana approach, with or without vitrectomy.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider makes an incision through the pars plana, a structure between the retina and the iris.
3. A gauge cutter, a precision cutting instrument, is inserted to incise the cataract material.
4. The provider removes the lens material by aspiration.
5. If necessary, the provider may also remove vitreous humor using a suction device.
6. The incision is closed with sutures, intraocular pressure is restored, and a topical antibiotic is administered.
7. An eye pressure patch is applied to the eye.

4. Qualifying circumstances

CPT 66852 is performed on patients with cataracts, a condition in which the lens of the eye becomes opaque, causing blurred vision. The procedure is done through a pars plana approach, which is a common access point for excision of the vitreous. The provider may also perform a vitrectomy, the surgical excision of the vitreous, during the procedure.

5. When to use CPT code 66852

CPT code 66852 should be used when the provider performs the removal of lens material through a pars plana approach, with or without vitrectomy. It is important to note that if the lens material requires phacofragmentation, the appropriate code to report is 66850. However, if only a partial posterior vitrectomy is necessary, CPT code 66852 should be used.

6. Documentation requirements

To support a claim for CPT 66852, the provider must document the following information:

• Patient’s diagnosis of cataracts
• Details of the procedure, including the pars plana approach and whether vitrectomy was performed
• Date of the procedure
• Incision technique and closure method
• Use of any additional instruments or devices
• Administration of topical antibiotic and application of an eye pressure patch

7. Billing guidelines

When billing for CPT 66852, ensure that the procedure meets the criteria for a pars plana approach and includes or excludes vitrectomy as appropriate. It is important to follow the specific documentation requirements and guidelines provided by the payer. Additionally, be aware of the appropriate use of modifier codes if necessary.

8. Historical information

CPT 66852 was added to the Current Procedural Terminology system on January 1, 1991. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a pars plana approach for the removal of lens material due to cataracts.
2. The provider performs a vitrectomy along with the removal of lens material through a pars plana approach.
3. A gauge cutter is used to incise the cataract material during the procedure.
4. The provider removes the lens material by aspiration and restores intraocular pressure.
5. An eye pressure patch is applied to the patient’s eye after the procedure.
6. The provider documents the details of the procedure, including the pars plana approach and closure method.
7. A topical antibiotic is administered to prevent infection.
8. The patient’s diagnosis of cataracts is documented in the medical record.
9. The procedure is performed using a pars plana approach, without the need for vitrectomy.
10. The provider uses a suction device to remove vitreous humor during the procedure.