How To Use CPT Code 66986

CPT 66986 describes the procedure for the exchange of an intraocular lens. 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 66986?

CPT 66986 can be used to describe the surgical procedure in which a previously placed intraocular lens is removed and replaced with a new one. This code is used when the physician makes an incision in the limbus or temporal area, removes the lens, and inserts a new lens of the correct power. The procedure may also involve an anterior vitrectomy and the injection of a balanced salt solution to check for any leakage.

2. Official Description

The official description of CPT code 66986 is: ‘Exchange of intraocular lens.’

3. Procedure

1. The physician administers local anesthesia to the patient.
2. An incision is made in the limbus or temporal area.
3. The loupe is cut off and any fibrosis is removed.
4. The previously placed intraocular lens is removed.
5. If necessary, an anterior vitrectomy is performed.
6. An intraocular lens of the correct power is inserted.
7. A balanced salt solution is injected to check for any leakage.
8. The incision is closed.

4. Qualifying circumstances

The exchange of an intraocular lens is typically performed in cases of incorrect positioning or the placement of a lens with the wrong power. This procedure is performed by a physician and requires the use of a specific diopter strength intraocular lens. The patient must have a previously placed intraocular lens that needs to be exchanged.

5. When to use CPT code 66986

CPT code 66986 should be used when a physician performs the exchange of an intraocular lens. It is appropriate to bill this code when the procedure involves the removal of a previously placed lens and the insertion of a new lens. This code should not be used for other intraocular lens procedures or for procedures performed by non-physician healthcare professionals.

6. Documentation requirements

To support a claim for CPT 66986, the physician must document the following information:

• Patient’s diagnosis and the need for the exchange of the intraocular lens
• Details of the procedure, including the incision site and any additional steps performed
• Type and power of the new intraocular lens inserted
• Use of any additional procedures, such as anterior vitrectomy
• Injection of balanced salt solution and any findings of leakage
• Details of the incision closure
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 66986, ensure that the procedure is performed by a physician and involves the exchange of an intraocular lens. This code should not be reported with other codes unless specified in the billing guidelines. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing for this procedure.

8. Historical information

CPT 66986 was added to the Current Procedural Terminology system on January 1, 1992. There have been no updates or changes to the code since its addition.

9. Examples

1. A physician performs the exchange of an intraocular lens for a patient with incorrect positioning of the previous lens.
2. A patient undergoes the exchange of an intraocular lens due to the placement of a lens with the wrong power.
3. A physician removes a previously placed intraocular lens and replaces it with a new lens of the correct power for a patient with cataracts.
4. An individual undergoes the exchange of an intraocular lens to improve their vision after experiencing complications with the previous lens.
5. A physician performs the exchange of an intraocular lens for a patient who desires an upgrade to a multifocal lens for improved near and far vision.
6. A patient undergoes the exchange of an intraocular lens to address complications such as inflammation or infection associated with the previous lens.
7. A physician performs the exchange of an intraocular lens for a patient with a history of lens dislocation or subluxation.
8. An individual undergoes the exchange of an intraocular lens to correct residual refractive errors after the initial lens placement.
9. A patient with a previously placed intraocular lens undergoes the exchange procedure to address issues such as glare or halos affecting their vision.
10. A physician performs the exchange of an intraocular lens for a patient who desires an upgrade to a toric lens for the correction of astigmatism.