OphthalmicASC Aug

AUG 2017

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wound after applying bipolar wet-field cautery to the superior sclera to achieve hemostasis. Attempts at bringing the lens out of the bag using vis- coelastic and hydration with BSS on a cannula were made. A lens loop and muscle hook were used to then express the lens nucleus from the capsular bag. The lens and cap- sular bag flipped upside down during this process. The superior wound needed to be widened using cornea-scleral scissors to allow extraction of the lens … the eye was reformed with balanced salt solution … The remaining cortical material was attempted to be removed with coaxial irrigation through the initial temporal clear corneal incision; however, at this point, it was noted that there was vitreous in the anterior chamber. Kenalog was injected into the anterior chamber to visualize the vitreous. Bimanual anterior vitrectomy was performed … A small amount of remaining cortical material and nuclear material in the anterior chamber was successfully removed using the anterior vitrector. Additional vitrectomy was performed as needed until there was no more vitreous found extending into the wounds…" [Note: per conversation with surgeon both lens and capsule were removed.] Case 3 Operative Note excerpts: "… A temporal clear cornea tunnel was then created … A continuous curvilinear capsulorrhexis was performed, followed by hydrodis- section. At this point, the anterior chamber deepened suddenly and iris prolapsed out of the wound. Posterior capsular rupture during hydrodissection was suspected. The iris was initially reposited successfully, but immedi- ately prolapsed with any slight manipulation of the eye. Therefore, it was reposited, and the main wound was closed with two interrupted 10-0 nylon sutures. During this time, the lens was seen to slowly sublux into the vitreous … Bimanual anterior vitrectomy was then performed to clear back all the prolapsed vitreous, and further vitrectomy was performed at the plane of the pos- terior capsule …. and [then] the remaining cortical material beneath the anterior lens capsule was carefully stripped away. There was about a half of a clock hour of cortex beneath the incision that could not be removed without threatening the anterior capsule and so this was left in place…" CONCLUSION Some of these complications may be anticipated by the physician, so the more extensive the chart documentation in the patient chart and operative notes, the better it is, especially in case of untoward circumstances. n CPT Codes copyrighted 2016 AMA. ICD-10-CM codes copyrighted 2017 Optum 360. References & Resources 1. Asbell RL. ASC Surgical Coding/Claims Processing. The Ophthalmic ASC; October 2015. 2. Asbell RL. Ophthalmic Quality Measure ASC-14: Unplanned Anterior Vitrectomy and Its Relationship to Cataract Surgery. The Ophthalmic ASC; February 2017. CASE 3 DIAGNOSES PROCEDURE CODES MODIFIERS 1) 1 66984 Phacoemulsification of cataract with insertion of IOL 74-RT Note: This case would qualify for Quality Measure: ASC—14 Unplanned Vitrectomy. Diagnosis: 1) H25.811 Combined forms of age-related cataract, right eye CASE 2 DIAGNOSES PROCEDURE CODES MODIFIERS 1) 1, 2 66920 Intracapsular cataract extraction, right eye RT 2) 3 67010 Mechanical anterior vitrectomy -51-RT Notes: 1. This case would qualify for Quality Measure: ASC—14 Unplanned Vitrectomy. 2. A very complicated case that ended up being coded as an intracapsular cataract extraction. 3. Not all MACs require modifier 51. Diagnosis: 1) H25.811 Combined forms of age-related cataract, right eye; 2) H21.81 Floppy iris syndrome; 3) H43.01 Vitreous prolapse, right eye T H E O P H T H A L M I C A S C | A U G U S T 2 0 1 7 32 C O D I N G & C O M P L I A N C E

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