Billing and Coding: Cataract Extraction

CPT 66982 (complex cataract extraction) is covered when the operative note documents devices or techniques beyond routine cataract surgery (for example, endocapsular rings, micro iris hooks via four incisions, Beechler-type expanders, synechialysis, permanent intraocular sutures, capsular support rings, dye staining, prosthetic iris, or primary posterior capsulorhexis), with specific ICD-10 diagnoses mapped to required documentation. Claims must include valid ICD-10 diagnosis codes, appropriate referring physician NPI when required, and signed medical records; ABN rules and appropriate GA/GX/GZ/GY modifiers must be followed and may cause automatic denials per MAC rules.

"CPT 66982 (complex cataract extraction) is covered when the procedure requires devices or techniques not generally used in routine cataract surgery."

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