Billing and Coding: Cataract Extraction (including Complex Cataract Surgery)

Medicare covers cataract extraction when the physician performing the preoperative ophthalmologic evaluation documents cataract as the primary diagnosis (per LCD L35091), and preoperative E/M may list cataract as primary or secondary when medically necessary. Complex cataract surgery is only payable when the record documents use of devices or techniques not generally used in routine cataract surgery (examples include iris hooks/retractors, Malyugin ring, sector iridectomy with repair, permanent intraocular sutures, or capsular support rings). All records must be legible, include patient identification and clinician signature, and support the selected ICD-10-CM and CPT/HCPCS codes.

"Cataract extraction is covered when the physician performing the preoperative ophthalmologic evaluation lists cataract as the primary diagnosis (ICD-10-CM codes per LCD L35091)."

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