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Complex extracapsular cataract removal with insertion of an intraocular lens (IOL) prosthesis is a specialized surgical procedure designed to address cataracts that present unique challenges. This one-stage procedure employs either manual or mechanical techniques, such as irrigation and aspiration or phacoemulsification, to effectively remove the cataract. The complexity of this surgery arises from the use of advanced devices or techniques that are not typically utilized in standard cataract surgeries. Such complexities may include the use of an iris expansion device, suture support for the IOL, or primary posterior capsulorrhexis, particularly in pediatric patients who are in the amblyogenic developmental stage. The procedure is particularly critical for children, as the anatomical and developmental characteristics of their eyes necessitate specific surgical approaches. For instance, the anterior capsule in children is more challenging to open, and the cortex is more difficult to remove due to lens adhesion. Additionally, certain ocular conditions, such as uveitis, glaucoma, pseudoexfoliation syndrome, or Marfan syndrome, can further complicate the surgery, necessitating a more intricate approach. Patients with a history of prior intraocular surgery, trauma to the eye, or those presenting with dense, hard, white cataracts may also require this complex procedure to ensure successful outcomes. The incorporation of endoscopic cyclophotocoagulation (ECP) during the surgery is particularly beneficial for glaucoma patients, as it can reduce the need for postoperative medication by treating the ciliary processes effectively.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure is indicated for patients presenting with complex cataracts that require advanced surgical techniques due to various factors. These include:
The procedure involves several detailed steps to ensure the successful removal of the cataract and insertion of the IOL:
Post-procedure care involves monitoring the patient for any complications and ensuring proper recovery. Patients may be advised on the use of prescribed medications to manage pain and prevent infection. Follow-up appointments are essential to assess the healing process and the effectiveness of the IOL. Patients should be informed about signs of potential complications, such as increased pain, vision changes, or signs of infection, and instructed to seek immediate medical attention if these occur. Additionally, the healthcare provider may discuss the need for ongoing management of any underlying conditions, such as glaucoma, particularly if ECP was performed during the surgery.
| Short Descr | XCAPSL CTRC RMVL CPLX W/ECP | Medium Descr | XCAPSL CTRC RMVL INSJ IO LENS PROSTH CPLX W/ECP | Long Descr | Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with endoscopic cyclophotocoagulation | Status Code | Carriers Price the Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 1 - Team surgeons could be paid, though... | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | none | MUE | 2 |
| RT | Right side (used to identify procedures performed on the right side of the body) | LT | Left side (used to identify procedures performed on the left side of the body) | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 54 | Surgical care only: when 1 physician or other qualified health care professional performs a surgical procedure and another provides preoperative and/or postoperative management, surgical services may be identified by adding modifier 54 to the usual procedure number. | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | SG | Ambulatory surgical center (asc) facility service |
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| 2020-01-01 | Added | Code added. |
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