CPT® Code 0617T

Official Description

Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with removal of crystalline lens and insertion of intraocular lens

Common Language Description

The procedure described by CPT® Code 0617T involves the insertion of an iris prosthesis, which is a specialized silicone disc designed to address issues related to a defective, missing, or damaged iris. This condition may arise from various causes, including acquired defects, trauma, congenital aniridia, or albinism. The iris prosthesis is custom-made for each patient, featuring a colorized design that includes a fixed diameter pupil, allowing it to closely match the appearance of the patient's other eye. The back of the prosthesis is designed with a black surface that effectively blocks light, permitting 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 fit the patient using a trephine, ensuring a precise fit. The prosthesis can be implanted into the capsular bag or the ciliary sulcus through a sclerocorneal approach, or it may be inserted via an 'open sky' approach during a concurrent penetrating keratoplasty. The insertion of the disc is performed by folding it and using forceps or an autoinjector for placement. Depending on the individual patient's anatomy and specific surgical requirements, the prosthesis may be secured with suture fixation. In cases where progressive zonulopathy leads to displacement, sutures may be applied later to ensure proper positioning. It is important to note that the placement of the artificial iris should ideally occur simultaneously with the insertion of an intraocular lens (IOL) for patients undergoing cataract surgery. This approach is crucial to prevent any deterioration in vision quality, particularly glare sensitivity, which may occur if the cataract is treated separately before addressing the iris defect. For coding purposes, CPT® Code 0616T is used for the insertion of the iris prosthesis alone, while CPT® Code 0617T is applicable when the procedure includes the removal of the crystalline lens and the insertion of an IOL for cataract patients. Additionally, CPT® Code 0618T is designated for cases involving prosthetic iris insertion with a secondary IOL placement or lens exchange.

1. Indications

The insertion of an iris prosthesis, as described by CPT® Code 0617T, is indicated for patients experiencing specific ocular conditions that necessitate the replacement or repair of the iris. These indications include:

Defective Iris The procedure is performed to address defects in the iris that may impair vision or cause aesthetic concerns.
Missing Iris Patients with congenital aniridia, a condition where the iris is absent from birth, may require an iris prosthesis to restore visual function and appearance.
Damaged Iris Trauma to the eye resulting in damage to the iris can lead to complications such as glare sensitivity, necessitating the insertion of a prosthetic iris.
Albinism Individuals with albinism may have underdeveloped or poorly functioning irises, and an iris prosthesis can help improve visual comfort and aesthetics.

2. Procedure

The procedure for the insertion of an iris prosthesis involves several critical steps, which are detailed as follows:

Step 1: Preparation The surgical site is prepared, and the patient is positioned appropriately for the procedure. Anesthesia is administered to ensure patient comfort during the surgery.
Step 2: Removal of Crystalline Lens If indicated, the crystalline lens is removed to facilitate the insertion of the intraocular lens (IOL) and the iris prosthesis. This step is crucial for cataract patients.
Step 3: Insertion of Intraocular Lens An intraocular lens is inserted into the capsular bag or ciliary sulcus, depending on the surgical approach and the patient's anatomy.
Step 4: Customization of Iris Prosthesis The outer diameter of the iris prosthesis is cut to size using a trephine, ensuring a proper fit for the patient’s eye.
Step 5: Insertion of Iris Prosthesis The iris prosthesis is folded and inserted into the eye using forceps or an autoinjector. The placement may involve suture fixation based on the surgical needs and anatomy of the patient.
Step 6: Final Adjustments The surgeon makes any necessary adjustments to ensure the proper positioning of the iris prosthesis and the IOL, checking for stability and alignment.

3. Post-Procedure

After the insertion of the iris prosthesis and IOL, patients are typically monitored for any immediate complications. Post-procedure care may include the use of prescribed medications, such as anti-inflammatory or antibiotic eye drops, to prevent infection and manage inflammation. Patients are advised on activity restrictions and follow-up appointments to assess healing and the function of the prosthesis. It is essential to monitor for any signs of displacement or complications related to the iris prosthesis, particularly in cases where suture fixation was utilized. The expected recovery period may vary based on individual patient factors and the complexity of the procedure.

Short Descr	INSJ IRIS PROSTH W/RMVL&INSJ
Medium Descr	INSJ IRIS PROSTH RMVL CRYSTLN LENS &INSJ IO LENS
Long Descr	Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with removal of crystalline lens and 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.

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.
GA	Waiver of liability statement issued as required by payer policy, individual case
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