Ophthalmic Coding Specialist Practice Test

When a patient undergoes cataract extraction and corneal transplantation, which CPT code should be listed first for optimal reimbursement?

1. CPT code 66984 (Cataract extraction)

2. CPT code 65730 (Keratoplasty)

3. CPT code 66821 (Intravitreal injection)

4. CPT code 66982 (Complex cataract surgery)

The correct answer is: CPT code 65730 (Keratoplasty)

For cataract extraction combined with corneal transplantation, the correct choice is to prioritize the CPT code for keratoplasty (corneal transplant) first. This is due to several factors related to the complexity and resource utilization of the procedures involved. When reporting surgical procedures for reimbursement, payers often emphasize the primary procedure that carries the highest risk and requires the most extensive resources. In this case, keratoplasty (CPT code 65730) is classified as a more complex visual restoration procedure when compared to cataract extraction. Typically, corneal transplantation involves additional surgical time, care, and a greater amount of post-operative management than a straightforward cataract surgery. Therefore, it is considered the primary procedure for coding purposes. Following this guideline, the correct coding practice is to list the keratoplasty first, as this aligns with both procedural hierarchy and payer expectations, ultimately promoting optimal reimbursement for the complex nature of the services rendered. In contrast, cataract extraction codes, such as 66984 or 66982, are usually secondary in this context since they do not involve the same level of complexity and resource need associated with the keratoplasty. Additionally, the option involving an intravitreal injection would not be relevant to this specific surgical combination scenario.