2025 CPT code 66852
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Eye and Ocular Adnexa Surgery Feed
Removal of lens material via pars plana approach, with or without vitrectomy.
Modifiers may be applicable depending on the specific circumstances of the procedure (e.g., -59 for distinct procedural service, if justified). Consult the current CPT manual and NCCI edits for appropriate modifier usage.
Medical necessity for 66852 is established by the presence of lens material impeding vision or interfering with other ophthalmologic procedures.This is supported by appropriate pre-operative diagnostic imaging and examination findings.In cases of combined procedures, the lens removal must be medically necessary to facilitate the primary procedure.
The ophthalmologist's responsibilities include pre-operative assessment, patient preparation and anesthesia, surgical removal of lens material and vitreous (if necessary) via pars plana approach, wound closure, intraocular pressure restoration, post-operative antibiotic administration, and application of eye patches. Post-operative follow-up care is also part of the clinical responsibility.
In simple words: The doctor removes cloudy lens material from the eye through a small incision.Sometimes, extra fluid is also removed. This helps to improve vision.
This CPT code encompasses the surgical removal of lens material through a pars plana approach.The procedure may or may not include a vitrectomy, depending on the clinical circumstances.It involves making an incision in the pars plana region of the eye, accessing and removing the lens material, and potentially removing vitreous humor if necessary. The incision is then closed, intraocular pressure is restored, and post-operative care is administered.
Example 1: A patient presents with a cataract causing significant vision impairment.The ophthalmologist performs a pars plana lensectomy to remove the cataractous lens, with no vitrectomy necessary., During a vitrectomy for a retinal detachment, the surgeon encounters significant lens fragments obstructing visualization of the retina.The lens fragments are removed using a pars plana approach as part of the vitrectomy procedure., A pediatric patient requires cataract removal.Due to the lens's location and the patient's age, a pars plana approach is used for lens removal, with minimal vitreous involvement.
Detailed operative notes describing the surgical approach (pars plana), technique of lens removal, whether a vitrectomy was performed, and the extent of vitreous removal.Pre-operative diagnostic findings supporting the need for lens removal, intraoperative findings, and post-operative course should also be documented.
** The decision to use 66852 versus 66850 should be based on the extent of the vitrectomy.If a significant vitrectomy is performed, 66850 might be more appropriate, and potentially require modifier -59 to unbundle it from the vitrectomy procedure, depending on payer and NCCI guidelines.Always adhere to the latest NCCI edits and payer-specific policies.
- Revenue Code: P4B (EYE PROCEDURE - CATARACT REMOVAL/LENS INSERTION)
- RVU: This information is not available in the provided text.Consult the current CPT manual or other relevant fee schedules for RVU values and reimbursement details.
- Global Days: This information is not available in the provided text. The global period will depend on payer-specific guidelines and the specific services included.Consult payer guidelines for details.
- Payment Status: Active
- Modifier TC rule: This information is not available in the provided text.This would depend on payer specific rules.
- Fee Schedule: This information is not available in the provided text. Consult historical CPT fee schedules for this information.
- Specialties:Ophthalmology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center