When I bill cataract surgery and goniosynechiolysis, the goniosynechiolysis is never paid. Is it appropriate to use goniosynechiolysis as justification for 66982 complex cataract surgery since it is a service not typically done during routine cataract surgery?

Answer: CPT code 65865 Goniosynechiolysis is bundled with cataract surgery by National Correct Coding Initiative (NCCI) edits. When performed on the same eye in the same session, it is not appropriate to unbundle.

The complex cataract surgery CPT descriptor includes “requiring devices or techniques not generally used in routine cataract surgery.” Each payer has their own coverage policy that defines what devices and other techniques qualify. Goniosynechiolysis would not qualify for complex cataract surgery.

NCCI edits can be checked in the Academy’s Ophthalmic Coding Coach. View Medicare coverage policies at aao.org/lcds.