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  • Ask the Expert Cataract/Anterior Segment

    What Constitutes a Complex Cataract Surgery Case?


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    What constitutes a complex cataract surgery case?

    Answer:
    Not every Medicare administrative contractor has a local coverage determination (LCD) policy for complex cataract surgery, but those that do provide similar indications. Verify your specific payer policy, including commercial and Medicaid plans.
    • A miotic pupil that will not dilate sufficiently and requires use of a mechanical iris expansion device (Iris retractors through four additional incisions, Beehler expansion device or Malyugin ring)
    • Preexisting zonular weakness requiring use of capsular tension rings or segments or intraocular suturing of the intraocular lens
    • Pediatric cataract surgery
    • Mature cataract (with use of correct ICD-10) requiring dye for visualization of capsulorrhexis
    The corresponding procedure note must support that devices or techniques not generally used in routine cataract surgery were used, for example: 
    • Insertion of iris retractors through additional incisions 
    • Mechanical expansion of the pupil using iris hooks
    • Creation of a sector iridectomy with subsequent suture repair of iris sphincter 
    • Use of intraoperative iris expansion device to maintain pupil dilation (i.e., Malyugin ring) iris sphincterotomies created with scissors 
    • The need to support the lens implant with permanent intraocular sutures
    • Placement of a capsular support ring is necessary to allow secure placement of an intraocular lens 
    You can find current ophthalmic LCDs at aao.org/lcds
    See also Cataract Surgeries Can Be Complex, Coding Doesn’t Have to Be.