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

Medicare billing for cataract extraction requires that the preoperative evaluation list cataract as the primary diagnosis and that submitted ICD-10-CM and CPT/HCPCS codes be supported by the medical record. Complex cataract surgery is covered only when the record documents use of devices or techniques not generally used in routine surgery (examples provided); non-covered services must not be billed as covered and require appropriate modifiers.

"The primary diagnosis submitted by the physician performing the preoperative ophthalmologic evaluation must be cataract (use the ICD-10-CM codes listed in the policy's 'ICD-10 Codes that Support Me..."

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