Would it be compliant for cataract surgeons to place a capsular tension ring in every eye with pseudoexfoliation, Marfan's syndrome, or high myopia because the patient is at risk for subluxation?

Answer:
The Academy’s Coding Coach lists Capsular glaucoma with pseudoexfoliation of lens, H40.1411 through H40.1434, as billable diagnoses with complex cataract surgery (CPT code 66982) when the medically necessary use of additional devices or techniques are appropriately documented. Marfan’s syndrome and high myopia are not included as covered diagnoses.

Confirm if your local Medicare administrative contractor’s LCD/LCA and each unique commercial carrier include these diagnoses in their coverage policy. Links to current LCD’s can be found at aao.org/lcds.

Stating that a capsular tension ring should be used in every case with the above diagnoses would not be appropriate. The use of a capsular tension ring would need to be medically necessary and the patient’s exam record and operative report should reflect the necessity. Prophylactic use would not be covered.