Question: Does use of miLoop qualify cataract surgery as complex?

Answer: According to the Academy’s Health Policy Committee, the use of miLOOP alone does not qualify as complex cataract surgery. There is no code currently for usage of miLOOP. In order for the case to be considered complex one of the following must be met:

1. A miotic pupil that will not dilate sufficiently to allow operative access to the lens and that requires the insertion of one of the following: Four iris retractors through four additional incisions; Beehler expansion device; a sector iridectomy with subsequent suture repair of; iris sphincter; or sphincterotomies created with scissors.
2. The presence of a disease state that produces lens support structures that are abnormally weak or absent. This requires the need to support the lens implant with permanent intraocular sutures, or alternately, a capsular tension ring may be necessary to allow placement of an intraocular lens.
3. Pediatric cataract surgery with implantation of IOL.

Note that while Medicare Administrative Contractors do allow for dye to be used with mature cataract, some commercial payers who do not follow Medicare guidelines may not.