CPT® Code 0618T

Official Description

Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with secondary intraocular lens placement or intraocular lens exchange

Common Language Description

The procedure described by CPT® Code 0618T 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 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 adjusted to fit the patient's eye using a trephine, ensuring a precise fit. The insertion can be performed through different approaches, including the capsular bag, the ciliary sulcus via a sclerocorneal approach, or through an 'open sky' technique during a concurrent penetrating keratoplasty. The disc is typically folded and inserted into the eye 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 the artificial iris should ideally occur simultaneously with the insertion of a secondary intraocular lens (IOL) for patients undergoing cataract surgery. This approach helps to prevent potential complications such as worsening vision and glare sensitivity that may arise if the cataract is treated separately before addressing the iris defect. For coding purposes, CPT® Code 0618T is specifically used when the iris prosthesis is inserted alongside a secondary IOL placement or lens exchange, distinguishing it from other related procedures that may involve the insertion of an iris prosthesis alone or in conjunction with the removal of the crystalline lens.

1. Indications

The insertion of an iris prosthesis, as described by CPT® Code 0618T, 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 for patients with a defective iris, which may result from trauma or other acquired defects that compromise the iris's integrity and function.
Missing Iris Patients with congenital aniridia, a condition characterized by the absence of the iris, may require an iris prosthesis to restore the appearance and function of the eye.
Damaged Iris Individuals with a damaged iris due to injury or surgical complications may benefit from the insertion of an iris prosthesis to improve visual outcomes and aesthetic appearance.
Albinism In cases of albinism, where the iris may be underdeveloped or absent, the insertion of an iris prosthesis can help in achieving a more natural appearance and potentially improve light sensitivity.

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. Anesthesia is administered to ensure patient comfort during the procedure.
Step 2: Sizing the Prosthesis The outer diameter of the iris prosthesis is cut to the appropriate size using a trephine, ensuring a precise fit for the patient's eye anatomy.
Step 3: Insertion Technique The iris prosthesis is folded and inserted into the eye. This can be accomplished using forceps or an autoinjector, depending on the surgeon's preference and the specific circumstances of the case.
Step 4: Suture Fixation (if necessary) Depending on the patient's anatomical considerations and surgical needs, the iris prosthesis may be secured with sutures. This is particularly relevant in cases where progressive zonulopathy may lead to displacement of the prosthesis.
Step 5: Secondary Intraocular Lens Placement If indicated, a secondary intraocular lens (IOL) is placed during the same surgical session to address any cataract-related issues, ensuring optimal visual outcomes.

3. Post-Procedure

After the insertion of the iris prosthesis, patients may require specific post-procedure care to ensure proper healing and recovery. This includes monitoring for any signs of complications, such as infection or displacement of the prosthesis. Patients are typically advised on the use of prescribed medications, including anti-inflammatory and antibiotic eye drops, to aid in the healing process. Follow-up appointments are essential to assess the positioning of the prosthesis and the overall health of the eye. Additionally, patients may need to be educated about potential changes in vision and light sensitivity as they adjust to the new prosthetic iris.

Short Descr	INSJ IRIS PROSTH SEC IO LENS
Medium Descr	INSJ IRIS PROSTH SECONDARY IO LENS PLMT/EXCHANGE
Long Descr	Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with secondary intraocular lens placement or intraocular lens exchange
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.
78	Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
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)