How To Use CPT Code 66991

CPT 66991 involves extracapsular cataract removal with intraocular lens prosthesis insertion and anterior segment aqueous drainage device placement. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 66991.

1. What is CPT 66991?

CPT 66991 is a medical procedure code used to describe extracapsular cataract removal with the insertion of an intraocular lens prosthesis and the placement of an anterior segment aqueous drainage device. This procedure is typically performed to treat cataracts and manage intraocular pressure in patients with glaucoma or other eye conditions.

2. 66991 CPT code description

The official description of CPT code 66991 is: “Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more.”

3. Procedure

1. The patient is prepped and anesthetized, typically with local anesthesia applied to the eye.
2. A small incision is made in the eye, and the provider enters the capsule to remove the hard nucleus from the lens.
3. The soft lens cortex is evacuated, leaving the capsule partially intact. Magnification is used to assist with visualization.
4. An intraocular lens prosthesis is inserted using a technique such as irrigation and aspiration (I&A) or phacoemulsification.
5. The provider uses a needle-like delivery device to enter the anterior segment of the eye and insert the drainage device into the trabecular meshwork.
6. One or more drainage devices may be placed during the session to help reduce pressure in the eye.
7. The provider closes the surgical wounds and places an antibiotic solution into the eye.

4. Qualifying circumstances

Patients eligible to receive CPT 66991 services are those diagnosed with cataracts and require intraocular lens prosthesis insertion, as well as those with conditions that necessitate the placement of an anterior segment aqueous drainage device, such as glaucoma. The procedure is typically performed when conservative treatments have not been effective in managing the patient’s condition.

5. When to use CPT code 66991

It is appropriate to bill the 66991 CPT code when a provider performs extracapsular cataract removal with intraocular lens prosthesis insertion and anterior segment aqueous drainage device placement in a single session. This code should be used when the procedure is medically necessary and has been determined to be the most appropriate treatment option for the patient’s condition.

6. Documentation requirements

Documentation supporting a claim for CPT 66991 should include a detailed medical history, a comprehensive eye examination, a diagnosis of cataracts or other relevant eye conditions, and a clear indication that the procedure is medically necessary. Additionally, the provider should document the specific techniques used during the procedure, the type and location of the intraocular lens prosthesis, and the number and placement of the anterior segment aqueous drainage devices. Postoperative care instructions and follow-up appointments should also be documented.

7. Billing guidelines

When billing for CPT code 66991, it is essential to follow the appropriate guidelines and rules. Ensure that the patient’s diagnosis supports the medical necessity of the procedure and that all required documentation is included in the patient’s medical record. Be aware of any payer-specific requirements or policies related to CPT 66991, and use the appropriate modifiers when necessary. Additionally, be familiar with any relevant coding updates or changes that may impact the billing process.

8. Historical information

CPT 66991 was added to the Current Procedural Terminology system on January 1, 2022. There have been no updates to the code since its addition.

9. Similar codes to CPT 66991

Five similar codes to CPT 66991 and how they differ are:

• CPT 66984: Extracapsular cataract removal with intraocular lens implant without concomitant aqueous drainage device.
• 0671T: Insertion of intraocular anterior segment drainage device into the trabecular meshwork without concomitant cataract removal with intraocular lens implant.
• CPT 66982: Extracapsular cataract removal with intraocular lens implant, complex, requiring devices or techniques not generally used in routine cataract surgery.
• CPT 66821: YAG laser capsulotomy for secondary cataract, which involves using a laser to create an opening in the lens capsule to improve vision.
• CPT 65775: Trabeculectomy, which is a surgical procedure to create a new drainage pathway for aqueous humor to lower intraocular pressure in glaucoma patients.

10. Examples

Here are 10 detailed examples of CPT code 66991 procedures:

1. A 65-year-old patient with a cataract and uncontrolled glaucoma undergoes extracapsular cataract removal with intraocular lens prosthesis insertion and placement of an anterior segment aqueous drainage device.
2. A patient with a dense cataract and a history of failed glaucoma medications undergoes CPT 66991 to improve vision and manage intraocular pressure.
3. A patient with a visually significant cataract and narrow-angle glaucoma undergoes CPT 66991 to prevent acute angle-closure glaucoma and improve visual acuity.
4. A patient with a cataract and a history of multiple failed glaucoma surgeries undergoes CPT 66991 as a combined procedure to address both conditions.
5. A patient with a cataract and uncontrolled glaucoma on maximum medical therapy undergoes CPT 66991 to improve vision and lower intraocular pressure.
6. A patient with a cataract and a history of uveitic glaucoma undergoes CPT 66991 to address both the cataract and the elevated intraocular pressure.
7. A patient with a cataract and a history of steroid-induced glaucoma undergoes CPT 66991 to remove the cataract and manage the glaucoma.
8. A patient with a cataract and a history of neovascular glaucoma undergoes CPT 66991 to address both the cataract and the elevated intraocular pressure.
9. A patient with a cataract and a history of pigmentary glaucoma undergoes CPT 66991 to improve vision and manage intraocular pressure.
10. A patient with a cataract and a history of pseudoexfoliative glaucoma undergoes CPT 66991 to address both the cataract and the elevated intraocular pressure.