The conjunctiva was opened in small limbal peritomies inferotemporally, supratemporally and supranasally. Only a few ophthalmic procedures are eligible to be billed with +66990 goniotomy is one of those. The IOL was folded and inserted into the posterior chamber, 1. The code was developed for primary cataract extraction using a pars plana approach wherein incidental vitreous may be removed but a core or complete vitrectomy is not performed. When you know preoperatively that both procedures will be performed, it is appropriate to unbundle by appending modifier 59 to 66984. For clinical responsibility, terminology, tips and additional info start codify free trial. Trabecular meshwork is incised and/or excised with a blade or other tool for at least several clock hours to create an opening of Schlemm's canal into the anterior chamber. 0. Note: Use 743.46 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil. Not all patients with visual acuity of 20/40 or worse require cataract surgery because: They are able to satisfactorily carry out their activities of daily living with changes in eyeglasses, lighting or other non-operative means. Selecting the Order of CPT Codes Normally, one lists the order of multiple Current Procedural Terminology (CPT) codes with the highest paying code first. E11.36 Type 2 diabetes mellitus with diabetic cataract 0000008857 00000 n Correct coding for the exam. 0000008745 00000 n H26.8 Other specified cataract 65850 Trabeculectomy ab externo65855 Trabeculoplasty by laser surgery66711 Ciliary body destruction; cyclophotocoagulation, endoscopic. Note: Use 366.02 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil. I [QUOTE="w_burns@peoplepc.com, post: 191710, member: 93259"]My doctor removed an ICL (Implantable Contact Lens) during cataract surgery. UnitedHealthcare will cover the cataract surgery (including the cost of the conventional lens) and the patient is responsible for the cost of the resbyopiacorrecting IOL to the extent it exceeds the cost of the conventional lens. Finding Medicare fee schedule HOw to Guide, Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee, LCD and procedure to diagnosis lookup How to Guide, Medicare claim address, phone numbers, payor id revised list, Medicare Fee for Office Visit CPT Codes CPT Code 99213, 99214, 99203. Note: Use 366.43 if the operative note or postoperative records indicate an extraordinary amount of work was involved in the preoperative or postoperative care. hb```b`` @1vnd``T5}R{ Basic coverage requirement for the co-management of a patient is that the surgeon MUST initiate the notification to Medicare Other specified anomalies of the iris and ciliary body. H40.89 Other specified glaucoma Formal visual fields; Q Does health insurance cover glaucoma surgery using goniotomy? A conventional IOL implanted following cataract surgery. nuclear cataract, bilateral 300-400 new vignettes are added each year as codes added, revised and reviewed. Note: Use 364.51 if the operative note indicates the use of an endocapsular ring to partially occlude the pupil. Electrophysiologic tests; H26.31 H26.413 Opens in a new window Drug-induced cataract, right eye Soemmerings ring, bilateral In order to help Otolaryngologist - Head and Neck Surgeons correctly code, the Academy helped the American Medical Association (AMA) draft a CPT Assistant article on the removal of impacted cerumen. Once the practitioner has seen the patient, that practitioner may bill for the period beginning with the date on which he assumes care of the patient. Covered IOL: V2630-V2632 Cardiothoracic SurgeryDiagnostic & Interventional CardiovascularDiagnostic RadiologyInterventional RadiologyPain ManagementVascular & Endovascular Surgery. In order for this claim to be accurate, the surgeon needs to know the date the optometrist assumed responsibility for the remaining post-operative care (the transfer date noted above). Note: Use 366.20 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil. Surgical intervention is part of the initial encounter (initial treatment). Corcoran Consulting Group (800) 399-6565 www.corcoranccg.com. 0000006989 00000 n ABiC and Visco360 are used in ab interno procedures. In this case, it would be necessary to show the dates during the postoperative period for which he/she was responsible in Item 19 of the CMS-1500 Form. Riva Lee Asbell shares insights into common retina surgical coding issues and areas of confusion with the host of Straight From the Cutters Mouth. H26.20 H26.213 Opens in a new window Unspecified complicated cataract Cataract with neovascularization, Answer: Use CPT code 65920 Removal of implanted material, anterior segment of eye. The diagnoses are appropriate, except use T85.79XA. The World Health Organization (WHO) owns the ICD-10. 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Neither should be used for coding complications or just because the case is complicated or difficultboth codes assume that the surgeon (and chart documentation) used prospective planning and there was prior knowledge of the complexity for the most part. One that meets, but does not exceed, the patients medical need. Code 67121 was actually developed for removal of an IOL dislocated into the posterior segment. A Trabeculotomy ab interno is an ophthalmic surgical procedure to incise and partially remove trabecular meshwork to create an opening into Schlemms canal by way of the anterior chamber angle. Note: Use 379.34 if the operative note indicates the IOL was supported by using permanent intraocular sutures, or a capsular support ring was employed. T85.22xA Malposition of intraocular lens. The date of service should be indicated as the date of surgery. A For a P-C IOL or A-C IOL inserted in a physicians office Unless the bundle is broken, an ambulatory surgery center (ASC) will not be reimbursed for its facility fee for the cataract surgery and IOL. 0000052080 00000 n 0000013237 00000 n Air-fluid exchange was performed multiple times to remove any remaining bubbles. A Yes. . Q: What is the proper coding for vitrectomy, IOL removal, and suturing of a new IOL? My front office staff was trying to schedule it in our system and the doctors office just wrote ICL removal and cataract sur My surgeon removed an ICL, then removed the cataract, then placed an IOL. You will have to append modifier -59 to get paid for the cataract and IOL insertion when performed in conjunction with retinal detachment repair. appears in the CPT manual after code 65235 (Removal of foreign body, intraocular; from anterior chamber of eye): "For removal of implanted material from anterior segment, use 65920." It is very important for physicians and ancillary staff to use the CPT manual as the primary coding source. Medicare will make payment for the lens based on reasonable cost for a conventional IOL. 0000039485 00000 n The patient has impairment of visual function due to cataract(s) resulting in: Decreased ability to carry out activities of daily living such as reading, viewing television, driving or meeting occupational or vocational expectations. infantile and juvenile cataract, bilateral Cataract removal is also indicated when the lens opacity inhibits optimal management of posterior segment disease or the lens causes inflammation (phakolysis, phakoanaphylaxis), angle closure, or medically unmanageable open-angle glaucoma. All claims submitted by a provider must be in accordance with the reporting guidelines and instructions contained in the most current CPT, HCPCS and ICD-10-CM publications. The following tests are generally not indicated in the preoperative workup for cataract surgery and, if performed, the indications for their use must be stated in the patients record: Potential vision testing; H35.371 Epiretinal membrane, right eye, 66850 Removal of lens material; phacofragmentation technique, mechanical or ultrasonic (eg, phacoemulsification), with aspiration, 66852 pars plana approach, with or without vitrectomy. History: The patient previously had a repair of a retinal detachment in the right eye using silicone oil and presents with an epiretinal membrane (ERM) and multiple inclusion cysts that are filled with the oil. o The provider who provides the post-operative care bills the same CPT code as the surgeon with modifier -55, e.g., 66984-55. This applies to all services: office visits, diagnostic tests, and surgery. Subscribe to Codify by AAPC and get the code details in a flash. Allowance of the postoperative care for each practitioner will be according to the number of days each practitioner was responsible for the patients postoperative care. Co-management of Postoperative Care for Cataract Surgery (CPT 66984) 0000054254 00000 n ICD-10-CM codes D12.0-D12.5 should be reported for patients with polyposis syndrome that may have small bowel neoplasia. Snellen visual acuity of 20/40 or worse. The appropriate level of E&M (9921X-57) or Eye code (9201X-57). Later the surgeon will submit a claim for his/her portion of post-operative care. Be aware that the latest revisions in cataract policies (local coverage determinations [LCDs]) for some Medicare administrative contractors (MACs) require that a formal form be filled out documenting the specific difficulties the patient is having with activities of daily living as a result of the cataract. H\0>ECIma} ta'/~q&.cIaN\pns6QMg}. You may dial extension 209 or 238 to speak with someone. 65920 - CPT Code in category: Removal Procedures on the Anterior Chamber of the Eye CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Examination of the retina revealed two horseshoe style breaks superotemporally. Infusion port was secured inferotemporally with 5-0 Mersilene. Focal endolaser is a higher paying code; however, prophylactic laser was not the purpose of the surgery and thus is not the reason the surgery was undertaken. A miotic pupil that will not dilate sufficiently to allow adequate visualization of the lens in the posterior chamber of the eye and that requires the insertion of four iris retractors through four additional incisions, Beehler expansion device, a sector iridectomy with subsequent suture repair of iris sphincter, or sphincterotomies created with scissors. Use of . The maximum appropriate interval between the preoperative examination and the date of surgery is three months in case there are significant changes in the patients health or vision. Triescence was placed over the macula and pick and forceps was used to elevate a sheet of epiretinal membrane off the macula., 2. CPT Code Set. Hi there to everybody, its my first go to see of this web site; this weblog consists of awesome and in fact good stuff for visitors. The general guidance for this code is that it is used for removal of implanted lens in eye. A: Various issues must be addressed in order to answer this question, beginning with the previously discussed premise of medical necessity. Coding for surgical procedures in the global period. So, the longstanding term for this procedure is goniotomy. A toric IOL replaces the natural lens and corrects astigmatism as well as distance vision, resulting in patients decreased postoperative dependence on glasses or contact lenses. Removal of implanted material, anterior seg-ment of eye 67121. Medicare coverage for cataract extraction with Intraocular Lens implant (IOL) is based on services that are reasonable and medically necessary for the treatment of beneficiaries who have a cataract. The appropriate CPT and ICD-10 codes would be: Explore TEPEZZA (teprotumumab-trbw) nowfor your patients with this serious, progressive disease. Iwork at an ASC and doc office booked it as a r Read a CPT Assistant article by subscribing to. A toric IOL replaces the natural lens and corrects astigmatism as well as distance vision, resulting in patients decreased postoperative dependence on glasses or contact lenses. Focal endolaser photocoagulation is bundled with 67121 and 67036. History: Retained lens fragments were in the pupil and anterior chamber of the left eye and blocked any view of the posterior pole. In addition, physicians inserting a P-C IOL or A-C IOL in an office setting may bill code V2632 (posterior chamber intraocular lens) for the IOL. H26.001 H26.003 Opens in a new window Unspecified infantile and juvenile cataract, right eye Unspecified Fee schedules are lists of the maximum allowable amount per unit for the associated HCPCS codes. Modifier 57 indicates that this is the exam to determine the need for surgery. Following are the current billing guidelines as published by National Government Services relative to practitioners who share postoperative management with another practitioner following cataract surgery, CPT 66984. Coding clues. View any code changes for 2023 as well as historical information on code creation and revision. Remove the iStent; perform ab interno trabeculectomy using the Trabectome; and perform pupilloplasty. Cataract (lens) fragments in eye following cataract surgery, bilateral Physicians, hospitals and ASCs may also report an additional HCPCS code, V2788, to indicate any additional charges that accrue when a P-C IOL or A-C IOL is inserted in lieu of a conventional IOL until January 1, 2008. A: This is a complicated question, and the answer depends on the specific clinical situation. Removal of implanted material, posterior segment; intraocular 66985. Transfer Date If Modifier 50 has been used then Medicare would pay 150% of allowed amount. Note: Use 366.21 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular suture, or a capsular support ring was employed. Fluorescein angiography; Does anyone know what the CPT code for removal of the Intacs implant would be? REIMBURSEMENT FOR GONIOTOMY OR TRABECULOTOMY AB INTERNO. Stacey, The date of service should be indicated as the date of surgery. Group 1 Codes. Note: Use 366.14 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil. A new sclerotomy was created further superiorly 3 mm posterior to the limbus and the Goretex suture moved to the new sclerotomy. Other third party payers set their own rates. Closed vitrectomy was carried out under wide field visualization. Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patients condition or to improve the function of a malformed body member. 0000026238 00000 n This column is a compilation of some of the most common questions that came up that day and my answers to them. Under certain circumstances, some of those CCI edits can be paid separately if you indicate to the payer (by appending a modifier code) that those circumstances apply. A CPT 65820 is considered a major surgical procedure; CMS defines it as having a 90-day postoperative period. The revenue codes and UB-04 codes are the IP of the American Hospital Association. Billing Guidelines CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. H25.091 H25.093 Opens in a new window Other age-related incipient cataract, right eye Other age-related incipient Viewhistorical information about the code including when it was added, changed, deleted, etc. Vitrectomy was performed to release the lens and allow it to fall back. Repetitive nerve stimulation in diagnosis of neuromuscular junction disorders such as myasthenia gravis, myasthenic syndrome. From the Operative Notes: The prominent conjunctival inclusion cysts nasal and infranasal were dissected. H25.11 H25.13 Opens in a new window Age-related nuclear cataract, right eye Age-related nuclear cataract, bilateral 0000048854 00000 n In CPT code definitions, note that, when a code is indented, the description up to the semicolon on the line above is included as a prefatory phrase to the indented material, as in the following example: 65920 Removal of implanted material, anterior segment of eye, 67025 Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange) with or without aspiration (separate procedure). 2023 Bryn Mawr Communications, LLC. Correct coding for the exam. 66984, and Modifier 55, which indicates post-operative management only. An Akreos lens was brought into the field and prepared by placement of Goretex sutures. Adjustment codes are sometimes too vague to clearly identify whether a Medicare Advantage Organization MAO denied payment for a service the Office You wont find these codes in your 2023 code books but they are effective April 1. Ophthalmic ultrasound B scan. Note: Use 364.81 or 364.89 if the operative note indicates the use of micro iris hooks inserted through four separate corneal incisions, Beehler or similar expansion device, multiple sphincterotomies created with scissors, sector iridotomy with suture repair of iris sphincter, the IOL implant was supported by using permanent intraocular sutures or a capsular support ring, or an endocapsular ring was used to partially occlude the pupil. A physician shall bill for a conventional IOL, regardless of a whether a conventional, P-C IOL, or A-C IOL is inserted (see section 120.2, General Billing Requirements). Although we believe this information is accurate at the time of publication, the reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication. 0000043065 00000 n H25.011 H25.013 Opens in a new window, H25.031 H25.033 Opens in a new window, subcapsular polar age-related cataract, bilateral, H25.041 H25.043 Opens in a new window, H25.091 H25.093 Opens in a new window, H26.001 H26.003 Opens in a new window, infantile and juvenile cataract, bilateral, H26.011 H26.013 Opens in a new window, Infantile and juvenile cortical, lamellar, or zonular cataract, bilateral, H26.031 H26.033 Opens in a new window, H26.041 H26.043 Opens in a new window, Anterior subcapsular polar infantile and juvenile cataract, bilateral, H26.051 H26.053 Opens in a new window, Posterior subcapsular polar infantile and juvenile cataract, bilateral, H26.061 H26.063 Opens in a new window, of infantile and juvenile cataract, bilateral, H26.111 H26.113 Opens in a new window, H26.121 H26.123 Opens in a new window, H26.131 H26.133 Opens in a new window, H26.221 H26.223 Opens in a new window, eye Cataract secondary to ocular disorders (degenerative) (inflammatory), bilateral, H26.231 H26.233 Opens in a new window, H26.491 H26.493 Opens in a new window, H59.021 H59.023 Opens in a new window, Cataract (lens) fragments in eye following cataract surgery, bilateral. 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Eye code ( 9201X-57 ) few ophthalmic procedures are eligible to be billed with +66990 goniotomy one... The IP of the retina revealed two horseshoe style breaks superotemporally by laser Ciliary... The conjunctiva was opened in small limbal peritomies inferotemporally, supratemporally and supranasally cost for a conventional IOL be. Of Straight From the Cutters Mouth will have to append modifier -59 to get for. Start codify free trial and revision the macula., 2 of surgery office booked it having! Defines it as having a 90-day postoperative period vignettes are added each year as codes added, revised and.! Code 67121 was actually developed for removal of the retina revealed two horseshoe style breaks superotemporally supratemporally supranasally! 65820 is considered a major surgical procedure ; CMS defines it as having a 90-day period... As a r Read a CPT 65820 is considered a major surgical procedure ; CMS defines as. 66984, and the answer depends on the specific clinical situation partially occlude the pupil allowed amount conjunction retinal. Subscribing to for clinical responsibility, terminology, tips and additional info start codify free trial n Other. The specific clinical situation, terminology, tips and additional info start codify free trial is part the. H40.89 Other specified glaucoma Formal visual fields ; Q Does health insurance cover surgery! 300-400 new vignettes are added each year as codes added, revised and.! Teprotumumab-Trbw ) nowfor your patients with this serious, progressive disease in ab procedures... Iol insertion when performed in conjunction with retinal detachment repair Trabeculoplasty by laser Ciliary... Endovascular surgery major surgical procedure ; CMS defines it as having a 90-day period. Q: What is the exam when performed in conjunction with retinal detachment repair was performed to release lens... 238 to speak with someone UB-04 codes are the IP of the left eye and blocked any view of Intacs! The need for surgery with someone used for removal of an IOL dislocated into the field and prepared by of! Level of E & amp ; M ( 9921X-57 ) or eye code 9201X-57! Dial extension 209 or 238 to speak with someone be indicated as the date of should! To be billed with +66990 goniotomy is one of those eligible to billed... Level of E & amp ; M ( 9921X-57 ) or eye code ( 9201X-57.... Under wide field visualization over the macula and pick and forceps was used to elevate sheet... Perform pupilloplasty which indicates post-operative management only implanted material, anterior seg-ment of eye 67121 Interventional! Peritomies inferotemporally, supratemporally and supranasally ABiC and Visco360 are used in ab interno procedures further superiorly 3 mm to. Under wide field visualization office booked it as having a 90-day postoperative period interno procedures stimulation! Cms defines it as having a 90-day postoperative period partially occlude the pupil and anterior chamber of the 65920 cpt code,... Applies to all services: office visits, diagnostic tests, and the answer depends on the clinical! The same CPT code for removal of implanted material, anterior seg-ment of 67121... Your patients with this serious, progressive disease information on code creation and revision ) nowfor your patients with serious... That both procedures will be performed, it is used for removal of the initial encounter ( initial ). Performed, it is used for removal of implanted lens in eye historical information on code and. Interno Trabeculectomy using the Trabectome ; and perform pupilloplasty procedures are eligible to be billed with goniotomy! Diabetic cataract 0000008857 00000 n Air-fluid 65920 cpt code was performed multiple times to remove any bubbles... Assistant article by subscribing to a flash retina surgical coding issues and areas of confusion with the previously discussed of... Surgerydiagnostic & Interventional CardiovascularDiagnostic RadiologyInterventional RadiologyPain ManagementVascular & Endovascular surgery sheet of epiretinal membrane off macula.. ( initial treatment ) is used for removal of the American Hospital Association Other specified cataract 65850 Trabeculectomy externo65855! Cover glaucoma surgery using goniotomy angiography ; Does anyone know What the CPT code as date! To determine the need for surgery Trabeculoplasty by laser surgery66711 Ciliary body destruction ; cyclophotocoagulation,.! Medical necessity as codes added, revised and reviewed the pupil code for removal of implanted material anterior! Shares insights into common retina surgical coding issues and areas of confusion with the host Straight! Host of Straight From the Cutters Mouth macula., 2 operative note indicates the Use of an dislocated! And ICD-10 codes would be: V2630-V2632 Cardiothoracic SurgeryDiagnostic & Interventional CardiovascularDiagnostic RadiologyInterventional ManagementVascular! Elevate a sheet of epiretinal membrane off the macula., 2 specified glaucoma Formal visual fields ; Q Does insurance! Diagnosis of neuromuscular junction disorders such as myasthenia gravis, myasthenic syndrome 00000 Correct. 90-Day postoperative period provider WHO provides the post-operative care bills the same CPT code as the surgeon with -55! A conventional IOL changes for 2023 as well as historical information on code creation and revision code was. Dial extension 209 or 238 to speak with someone a flash in eye will have to append -59. Is appropriate to unbundle by appending modifier 59 to 66984 focal endolaser photocoagulation is with. Interno procedures the Intacs implant would be allow it to fall back term for this procedure goniotomy. N ABiC and Visco360 are used in ab interno procedures insertion when performed in conjunction with retinal repair... Supratemporally and supranasally care bills the same CPT code for removal of an endocapsular ring to partially occlude pupil. Was opened in small limbal peritomies inferotemporally, supratemporally and supranasally n Air-fluid exchange was performed multiple times remove... & amp ; M ( 9921X-57 ) or eye code ( 9201X-57.. Placement of Goretex sutures ab externo65855 Trabeculoplasty by laser surgery66711 Ciliary body destruction ; cyclophotocoagulation, endoscopic the Trabectome and! Was carried out under wide field visualization a new IOL surgery using goniotomy post-operative only. Medicare would pay 150 % of allowed amount added each year as codes added, revised and reviewed and. Will have to append modifier -59 to get paid for the exam to determine need. Endolaser photocoagulation is bundled with 67121 and 67036 folded and inserted into the field prepared. Be billed with +66990 goniotomy is one of those view any code changes for 2023 as well historical! Terminology, tips and additional info start codify free trial care bills the same CPT as. A claim for his/her portion of post-operative care of neuromuscular junction disorders such as myasthenia,! Prominent conjunctival inclusion cysts nasal and infranasal were dissected 67121 and 67036 if the operative Notes the... 90-Day postoperative period Trabeculoplasty by laser surgery66711 Ciliary body destruction ; cyclophotocoagulation, endoscopic 0000013237... To all services: office visits, diagnostic tests, and modifier 55 which! Modifier 50 has been used then medicare would pay 150 % of allowed amount AAPC get... Iol: V2630-V2632 Cardiothoracic SurgeryDiagnostic & Interventional CardiovascularDiagnostic RadiologyInterventional RadiologyPain ManagementVascular & Endovascular surgery the IP of retina... Mellitus with diabetic cataract 0000008857 00000 n H26.8 Other specified glaucoma Formal visual fields Q... Be addressed in order to answer this question, beginning with the previously discussed premise of medical necessity partially! Disorders such as myasthenia gravis, myasthenic syndrome have to append modifier -59 to get 65920 cpt code for the to. With the previously discussed premise of medical necessity myasthenia gravis, myasthenic syndrome 00000! Is one of those h40.89 Other specified glaucoma Formal visual fields ; Q health. And inserted into the field and prepared by placement of Goretex sutures Formal visual fields ; Q Does health cover. Tips and additional info start codify free trial fragments were in the pupil and chamber. 2 diabetes mellitus with diabetic cataract 0000008857 00000 n Air-fluid exchange was performed multiple times to remove any bubbles... Treatment ) speak with someone to fall back is goniotomy: office,! Interno procedures Straight From the operative note indicates the Use of an endocapsular ring to occlude... Of a new sclerotomy was created further superiorly 3 mm posterior to the new sclerotomy IOL dislocated into the segment. Post-Operative management only, bilateral 300-400 new vignettes are added each year as codes added, revised and reviewed as...