CPT Code 66984: Cataract Surgery with Intraocular Lens Implant

What is CPT code 66984?

CPT code 66984 denotes a medical procedure involving the removal of a cataract through extracapsular cataract extraction, phacoemulsification, and intraocular lens (IOL) implantation. This code specifically describes a one-stage procedure that includes the removal of the cataract and the placement of an artificial lens during the same operative session.

The procedure, commonly known as modern cataract surgery, utilizes a technique called phacoemulsification, which involves ultrasonic energy to break up and remove the clouded natural lens. This is followed by the insertion of an intraocular lens prosthesis. CPT 66984 represents the complete intervention and is a commonly performed ophthalmic procedure.

When a physician reports CPT code 66984, it specifies that the cataract extraction is performed using the phacoemulsification technique with subsequent insertion of intraocular lens (IOL) during the same operative session. This comprehensive code encompasses:

• Pre-operative assessment of the cataract
• Administration of appropriate anesthesia
• Creation of small incisions in the eye
• Phacoemulsification to fragment and remove the clouded lens
• Insertion of an intraocular lens in the capsular bag
• Wound closure and immediate post-operative evaluation

The code description explicitly indicates that both the extraction and lens implantation are included, distinguishing it from procedures where only cataract removal is performed without an intraocular lens implant.

CPT code 66984 documentation requirements

Proper documentation is essential to support medical necessity for cataract surgery and ensure appropriate reimbursement. Healthcare providers must maintain detailed records that justify the need for surgical intervention.

To establish medical necessity for CPT code 66984, documentation should include:

• Comprehensive eye examination findings
• Visual acuity measurements showing functional impairment
• Diagnosis confirming the presence and severity of cataract
• Documentation of how the cataract affects the patient's daily activities
• Failed conservative management, if applicable
• Detailed operative report outlining the specific techniques used

Most Medicare Administrative Contractor (MAC) policies require documentation of decreased visual acuity, glare, or other visual symptoms that interfere with activities of daily living before approving cataract surgery.

Complete documentation also includes properly executed informed consent that outlines:

• Risks and benefits of the procedure
• Alternative treatment options
• Expected outcomes and potential complications
• Discussion of IOL options and their implications
• Understanding of postoperative care requirements

Documentation should also clearly establish that both the extracapsular cataract removal and insertion of intraocular lens occurred during the same operative session by the same physician.

CPT code 66984 billing guidelines

Understanding the billing guidelines for CPT code 66984 is crucial for healthcare providers to receive accurate reimbursement for cataract surgery services.

Specific reimbursement rates for CPT code 66984 vary based on multiple factors:

• Geographic location (influenced by specific geographic practice cost indices)
• Setting where the procedure is performed (hospital outpatient department vs ambulatory surgical center)
• Medicare physician fee schedule (MPFS) or individual payer rates
• Relative value units (RVUs) assigned to the procedure

Several modifiers may be applicable when reporting CPT code 66984, each with specific implications for reimbursement:

• Modifier -50: Used when cataract surgery is performed on both eyes during the same operative session (bilateral procedure)
• Modifier -LT/-RT: Indicates which eye underwent the procedure (left or right)
• Modifier -79: Used for unrelated procedures during the postoperative period
• Modifier -58: For staged or related procedures planned during the global period

Proper application of these modifiers is essential to recover revenue rightfully owed for services rendered. For instance, when cataract surgery is performed bilaterally, using modifier -50 rather than filing two separate claims can significantly impact reimbursement.

Other relevant codes

When coding for cataract surgery services, several related CPT codes may be applicable depending on specific circumstances:

• 66982: Complex cataract extraction with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification), requiring devices or techniques not generally used in routine cataract surgery
• 66983: Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one-stage procedure)
• 66985: Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
• 66986: Exchange of intraocular lens
• 66987: Extracapsular cataract removal with insertion of intraocular lens prosthesis (one-stage procedure), manual or mechanical technique, with endoscopic cyclophotocoagulation