Billing and Coding: Cataract Extraction

Cataract extraction is covered when medically necessary, including to provide an unimpeded view of the fundus for posterior segment disease, for visually significant aniseikonia from anisometropia after prior IOL implantation, and for complex cases requiring non-routine devices or techniques (CPT 66982/66987). Claims must include a valid ICD-10 diagnosis, appropriate laterality modifiers, and required referring/ordering NPI when applicable; operative and medical records must document medical necessity and, for complex codes, explicit operative findings or techniques used. Procedure coding may be subject to NCCI or OPPS edits and claims lacking required documentation or diagnosis codes may be returned or adjusted.

"Cataract extraction is covered when necessary to provide an unimpeded view of the fundus to allow proper management of posterior segment disease, with the cataract diagnosis billed as primary and t..."