CPT® 66984: Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation - JF Part B
CPT® 66984: Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation
In order to fulfill its contractual obligation with CMS, Noridian Healthcare Solutions (Noridian), your Medicare Contractor, performs pre-payment reviews in accordance with CMS direction. CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. Medical review assesses submitted documentation to validate provider compliance with Medicare payment rules and regulations, including coverage, coding and billing guidelines.
This is to update providers of the claim review findings for CPT® 66984; Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation. The results of this focused review are not a reflection on providers' competence as a health care professional or the quality of care provided to patients. Specifically, the results are based on the documentation requested by Medicare and/or your facility's compliance with the required documentation.
The Jurisdiction F, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 66984; Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation. The quarterly edit effectiveness results from July 1, 2024 to September 30, 2024, are as follows:
Top Denial Reasons
- The documentation submitted was incomplete and/or insufficient.
- The documentation submitted does not support medical necessity as listed in coverage requirements in the National Coverage Determination or Local Coverage Determination
Educational Resources
- How to Respond to ADR
- Documentation Guidelines for Medicare Services
- Cataract Surgery in Adults LCD L37027
Education
In extracapsular cataract extraction (ECCE), the anterior shell and the nucleus of the lens capsule are removed, leaving the posterior shell of the lens capsule in place. The physician inserts a lid speculum between the patient's eyelids and makes an incision in the corneal-scleral juncture (the limbus). To enhance the flow of fluids in the eye, the physician may create a hole in the iris. Using a cutting and suction or ultrasonic device, the physician removes the lens in parts: first the anterior lens, then the inner, hard nucleus. The clear, posterior capsule remains. The physician injects a bubble of air into the anterior chamber to protect the cornea. The physician guides the intraocular implant into the eye. The haptics (securing attachments) lodge into the ciliary sulcus or the lens capsule, occupying the exact position of the original cataract. The physician may close the incision with sutures and may restore the intraocular pressure with an injection of water or saline. A topical antibiotic or pressure patch may be applied.
Failure to Return Records
The Internet-Only Manual (IOM) addresses timeframes for submission of records for pre-payment reviews in the Medicare Program Integrity Manual, Publication 100-08, Chapter 3, Section 3.2.3.2.
"When requesting documentation for prepayment review, the MAC and ZPIC shall notify providers that the requested documentation is to be submitted within 45 calendar days of the request. The reviewer should not grant extensions to providers who need more time to comply with the request. Reviewers shall deny claims for which the requested documentation was not received by day 46."
Incomplete And/or Insufficient Documentation
When additional documentation has been requested to verify compliance with the CPT® code billed and the submitted documentation lacks evidence to support that, the claim will be denied as the documentation submitted was incomplete and/or insufficient. Refer to Internet Only Manual (IOM), Publication (Pub) 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8(C).
For additional educational resources, please visit our Education and Outreach department.
