How To Use CPT Code 66985

CPT 66985 describes the insertion of an intraocular lens prosthesis (secondary implant) into the eye of a patient who had previously undergone cataract removal. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 66985?

CPT 66985 is used to describe the procedure of inserting an intraocular lens prosthesis into the eye of a patient who had previously undergone cataract removal. This code is specifically for cases where the patient did not have a lens implanted during the initial cataract surgery. The purpose of the secondary implant is to replace the absent lens and improve the patient’s vision.

2. Official Description

The official description of CPT code 66985 is: ‘Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal.’

3. Procedure

1. After administering local anesthesia, the healthcare provider makes a scleral incision.
2. Using a lens inserter, the provider inserts an intraocular lens of a specific power into the eye.
3. The lens is then sutured to the sclera or iris to ensure proper positioning and stability.

4. Qualifying circumstances

CPT 66985 is performed in cases where the patient had previously undergone cataract removal but did not have a lens implanted during that surgery. This procedure is typically done in complicated cases or when the ophthalmologist determines that an intraocular lens implant is necessary after the initial cataract surgery.

5. When to use CPT code 66985

CPT code 66985 should be used when a healthcare provider performs the secondary implant of an intraocular lens prosthesis in a patient who had previously undergone cataract removal without lens implantation. It is important to note that this code should not be used if the secondary implant is performed concurrently with cataract removal. In such cases, different codes, such as 66982, 66983, or 66984, should be used.

6. Documentation requirements

To support a claim for CPT 66985, the healthcare provider must document the following information:

• Patient’s history of cataract removal without lens implantation
• Date of the secondary implant procedure
• Details of the procedure, including the specific power of the intraocular lens and the method of fixation (scleral or iris)
• Any complications or additional procedures performed during the surgery
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 66985, ensure that the procedure meets the criteria of a secondary implant of an intraocular lens prosthesis. It should not be associated with concurrent cataract removal. It is important to review the extensive notes included with this descriptor to determine which codes can or cannot be reported together with CPT 66985. Additionally, consider any specific guidelines provided by the payer or insurance company.

8. Historical information

CPT 66985 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient who previously had cataract removal without lens implantation undergoes a secondary implant of an intraocular lens prosthesis to improve their vision.
2. An ophthalmologist performs the insertion of an intraocular lens prosthesis in a patient who had complicated cataract surgery in the past but did not have a lens implanted.
3. A healthcare provider performs a secondary implant of an intraocular lens prosthesis in a patient who had cataract surgery several years ago and now requires lens replacement.
4. An ophthalmologist performs the insertion of an intraocular lens prosthesis in a patient who had cataract surgery in the past but experienced lens dislocation.
5. A patient who had cataract surgery without lens implantation undergoes a secondary implant of an intraocular lens prosthesis to correct their aphakia.
6. An ophthalmologist performs the insertion of an intraocular lens prosthesis in a patient who had cataract surgery previously but did not have a lens implanted due to complications.
7. A healthcare provider performs a secondary implant of an intraocular lens prosthesis in a patient who had cataract surgery several years ago and now requires lens replacement due to refractive error.
8. An ophthalmologist performs the insertion of an intraocular lens prosthesis in a patient who had cataract surgery in the past but developed significant visual impairment.
9. A patient who previously had cataract removal without lens implantation undergoes a secondary implant of an intraocular lens prosthesis to correct their vision.
10. An ophthalmologist performs the insertion of an intraocular lens prosthesis in a patient who had cataract surgery in the past but experienced lens dislocation and subsequent vision deterioration.