Interventional Glaucoma: iTrack Canaloplasty and iDose

I. Paul Singh, MD

Eyetube

In this case, I. Paul Singh, MD, presents a patient with mild open-angle glaucoma and a history of cataract surgery without MIGS, who is still taking three glaucoma drops after selective laser trabeculoplasty. He performs iTrack canaloplasty (Nova Eye Medical) and iDose implantation (Glaukos). Financial Disclosure: Consultant (Glaukos, Nova Eye Medical)

Left Behind

A rare complication of cataract surgery can cause a range of visual problems.

Kianna Swanson, OD, and Jacob Lang, OD, FAAO

Modern Optometry

Cataract surgery is one of the most frequently performed procedures worldwide with generally high success rates. Despite its routine nature and various technological advances, a range of ocular complications may still arise. One uncommon yet clinically significant complication is the retention of lens fragments. A REFRESHER ON RETAINED LENS FRAGMENTS The human crystalline lens consists of an anterior and posterior capsule, cortex, and central nucleus. Following phacoemulsification, an ultrasonic disruption, and removal of the natural lens, retained lens fragments are reported to occur in approximately 0.1% of cases.1 These fragments may consist of cortical and/or nuclear material and can lead to a spectrum of complications, including decreased vision, corneal edema, anterior chamber inflammation, macular edema, and/or retinal detachment. Retained lens fragments may be found in the anterior chamber, posterior chamber, vitreous cavity, or capsular bag. Nuclear fragments are yellow in color with sharp edges, whereas cortical fragments appear white and fluffy. Although most retained lens fragments are seen in the early postoperative days, in some cases, it may be decades before they are identified or pose a threat to the patient’s ocular health.2 WHAT TO DO ABOUT RETAINED LENS FRAGMENTS Early recognition, material identification, and appropriate management are critical to ensure positive patient outcomes. Most retained lens fragments can be easily seen during the slit-lamp examination (Figure); however, gonioscopy and B-scan ultrasonography may allow better visualization and localization. Management typically involves surgical removal of the fragments, although cortical lens fragments may dissolve spontaneously over time.

10 Essential Steps for Accurate Retina Surgery Coding

Keeping these in mind, practices can reduce errors, prevent denials, and maintain accurate billing.

Joy Woodke, COE, OCS, OCSR, and Matthew Baugh, MHA, COT, OCS, OCSR

Retina Today

Ensuring proper reimbursement for ophthalmic surgery demands more than simply selecting a CPT code—it requires a structured, methodical approach to coding. A consistent review process helps safeguard against denials, clarify complex billing combinations, and accurately reflect what occurred in the OR. The following example shows how to apply 10 necessary steps for successful surgical coding (Figure). Figure. Following these 10 steps can help surgeons code carefully and enjoy proper reimbursement. OPERATIVE SUMMARY The operative note describes a patient who underwent a pars plana vitrectomy (PPV) to address a dislocated posterior chamber IOL in the left eye. The IOL was split into two fragments, and during surgery, each piece was carefully elevated, cut, and removed through a clear corneal incision under the protection of viscoelastic. After clearing the posterior segment, the surgeon placed a new posterior chamber IOL. A peripheral iridotomy was created to remove residual viscoelastic, and subconjunctival injections of dexamethasone and cefazolin were administered. Step 1: Identify All Possible CPT Codes and Read Full Descriptors Using the documentation in the operative report, identify every CPT code that could apply to the documented procedures.