Our physician could not complete cataract surgery because of zonular dialysis discovered intraoperatively and we billed 66850. Two days later the surgery was completed with the use of capsular tension ring to dilate the iris for floppy iris syndrome and zonular dialysis. Do we bill 66982 with a 52 modifier since the capsular tension ring was used?

Answer:
CPT code 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique, complex is inappropriate because the second procedure did not include removing the cataract.

CPT code 66985 -58 – (eye modifier) Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal is the optimal answer. If the second procedure was not a planned procedure at the time of the cataract removal, then 66985 -78– (eye modifier) is also acceptable. However, -58 allows the full fee schedule, and a new global period begins; modifier -78 reduces the allowable by 20%, and the original global period continues.

Additionally, note that CPT code 66985 has a higher RVU value than 66982.

Education on modifier use can be found in chapter 5 of Fundamentals of Ophthalmic Coding.