5. Does documentation support the required diagnoses are present (primary and secondary codes, if applicable)?

Yes No

6. Has a medical history and physical examination been completed by the ordering provider as it relates to the complaint of the patient for that visit?

Yes No

10. The patient has impairment of visual function due to cataract(s) and all of the following criteria are met and clearly documented:

Decreased ability to carry out activities of daily living
Patient has a best corrected visual acuity of 20/50 or worse at distant or near; or additional testing shows either consensual light testing decreases visual acuity by two lines or glare testing decreases visual acuity by two lines
The record reflects that the cataract is the primary cause of decreased visual acuity and/or functional impairment; other diseases have been ruled out. OR there is documentation of phacomorphic or phacolytic glaucoma. OR there is documentation that the cataract obscures an adequate view of the fundus which is necessary for monitoring and/or treatment of diseases of the posterior segment of the eye

Yes No

11. Does the documentation support the extraordinary work performed during interoperative or postoperative periods in a subset of cataract operations including:

Miotic pupil which will not dilate sufficiently to allow adequate visualization of the lens in the posterior chamber of the eye and which requires the insertion of 4 iris retractors through 4 additional incisions.
The presence of a disease state that produces lens support structures that are abnormally weak or absent. This requires the need to support the lens implant with permanent intraocular sutures and/or a capsular support ring may be necessary to allow placement of an intraocular lens.

Yes No