Anthem Issues Guidelines for Monitored, General Anesthesia for Cataract Surgery

February 2018 ~

Anthem has released an update to its clinical guidelines for monitored anesthesia care and general anesthesia for cataract surgery stating that it will no longer be required for an anesthesiologist or nurse anesthetist to monitor anesthesia during cataract surgery.

In its guidelines, the insurer states the administration of monitored anesthesia care (MAC) or general anesthesia for cataract surgery is considered not medically necessary, unless the following criteria are met:

  • Children less than 18 years of age; or
  • Individuals who are unable to cooperate or communicate (for example, dementia, acute agitation, or movement disorder); or
  • Individuals who are unable to lie flat (for example, severe back pain, congestive heart failure); or
  • Individuals who have failed or have contraindications to topical, local, regional, or moderate sedation anesthesia; or
  • Anticipation of prolonged or complex surgery.

Anthem lists the following applicable codes for treatments and procedures:

CPT

  • 00142 – Anesthesia for procedures on eye; lens surgery (when specified as cataract surgery)

ICD-10

  • 36 – Type 1 diabetes mellitus with diabetic cataract
  • 36 – Type 2 diabetes mellitus with diabetic cataract
  • 011-H25.9 – Age-related cataract
  • 001-26.9 – Other cataract
  • H28 – Cataract in diseases classified elsewhere
  • 0 – Congenital cataract
  • 41-Z98.49 – Cataract extraction status

 

CPT® is a registered trademark of the American Medical Association.

 

Source(s): HealthcareDIVE; Anthem; Kaiser Health News;

 

 

 

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