Question: I commonly recertify all pars plana vitrectomies, consent patients for the same and perform this during complex cataract cases or IOL exchanges etc. For example, subluxed dense cataracts with vitreous in the anterior chamber, dislocated IOLs with Yamane fixation. When it comes to submitting billing, should I code the pars plana vitrectomy (PPV) first then 66982 Complex cataract extraction? In the case of the exchange PPV first then 66986?

Answer: According to multiple procedure protocol, list the CPT codes in order of relative value units (RVU)/or the payer fee schedule, highest to lowest.

For the examples provided: 

• 67036 Vitrectomy first
• 66982 Complex cataract surgery. Payment will be 50% of the allowable per multiple procedure payer guidelines.

• 66986 IOL exchange
• 67036 Vitrectomy. Payment will be 50% of the allowable per multiple procedure payment guidelines.

For more examples complex retina/lens visit aao.org/retinapm.