CPT® Code 0616T

Official Description

Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lens

Common Language Description

The procedure described by CPT® Code 0616T involves the insertion of an iris prosthesis, which is a specialized silicone disc designed to address various conditions affecting the iris. This procedure is indicated for patients with a defective, missing, or damaged iris resulting from acquired defects, trauma, congenital aniridia, or albinism. The iris prosthesis is custom-made to fit the individual patient, featuring a colorized design that includes a fixed diameter pupil to match the appearance of the other eye. The back of the prosthesis is designed with a black surface that effectively blocks light, allowing it to pass only through the pupil, thereby mimicking the natural function of the iris. During the surgical procedure, the outer diameter of the iris prosthesis is tailored to the patient's specific needs using a trephine, ensuring a precise fit. The insertion can be performed through various approaches, including the capsular bag, the ciliary sulcus via a sclerocorneal approach, or through an 'open sky' technique during a concomitant penetrating keratoplasty. The disc is typically folded and inserted manually using forceps or an autoinjector, and in some cases, suture fixation may be employed based on the patient's anatomical considerations and surgical requirements. It is important to note that the placement of an artificial iris should ideally occur simultaneously with the insertion of an intraocular lens (IOL) for patients undergoing cataract surgery. This approach helps to prevent potential complications such as glare sensitivity that may arise if the cataract is treated separately before addressing the iris defect. For accurate coding, CPT® Code 0616T should be reported for the insertion of the iris prosthesis alone, while additional codes are designated for procedures involving the removal of the crystalline lens and insertion of an IOL or for secondary IOL placements.

1. Indications

The insertion of an iris prosthesis is indicated for patients presenting with specific conditions affecting the iris. These include:

Defective Iris - Conditions where the iris is not functioning properly due to various factors.
Missing Iris - Cases of congenital aniridia where the iris is absent from birth.
Damaged Iris - Trauma or injury leading to the loss or damage of the iris structure.
Congenital Aniridia - A genetic condition resulting in the absence of the iris.
Albinism - A condition that may affect the pigmentation and structure of the iris.

2. Procedure

The procedure for the insertion of an iris prosthesis involves several critical steps to ensure proper placement and functionality of the device. The following outlines the procedural steps:

Preparation and Anesthesia - The patient is prepared for surgery, and appropriate anesthesia is administered to ensure comfort during the procedure.
Accessing the Eye - The surgeon gains access to the eye through a suitable surgical approach, which may include a sclerocorneal incision or an open sky technique, depending on the specific case and the presence of other ocular conditions.
Customization of the Iris Prosthesis - The outer diameter of the iris prosthesis is cut to size using a trephine, ensuring a precise fit for the patient’s anatomy.
Insertion of the Iris Prosthesis - The flexible silicone disc is folded and inserted into the eye using forceps or an autoinjector. The insertion technique may vary based on the surgical approach and the patient's anatomical considerations.
Suture Fixation (if necessary) - Depending on the patient's anatomy and surgical needs, the iris prosthesis may be secured with sutures at the time of insertion or later if there is a risk of displacement due to progressive zonulopathy.

3. Post-Procedure

After the insertion of the iris prosthesis, patients typically require monitoring for any immediate complications. Post-procedure care may include the use of anti-inflammatory medications and antibiotics to prevent infection and manage inflammation. Patients are advised on activity restrictions and follow-up appointments to assess the healing process and the functionality of the prosthesis. It is essential to monitor for any signs of displacement or complications related to the prosthesis, especially in cases where suture fixation was utilized. The expected recovery time may vary based on individual patient factors and the complexity of the procedure.

Short Descr	INSERTION OF IRIS PROSTHESIS
Medium Descr	INSJ IRIS PROSTH W/SUTURE FIXATION&RPR/RMVL IRIS
Long Descr	Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lens
Status Code	Carriers Price the Code
Global Days	YYY - Carrier Determines Whether Global Concept Applies
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.

58	Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
79	Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
GA	Waiver of liability statement issued as required by payer policy, individual case
GC	This service has been performed in part by a resident under the direction of a teaching physician
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)
SG	Ambulatory surgical center (asc) facility service