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CMS and commercial payers require specific documentation of at least one complexity factor to justify the higher-paying code: Small pupil requiring mechanical dilation devices or iris hooks Dense brunescent or white mature cataract requiring additional phaco time/power Weak or absent zonules (pseudoexfoliation syndrome, trauma, Marfan syndrome) Pediatric cataract (under age 18) Prior vitrectomy with compromised posterior capsule support Intraoperative floppy iris syndrome (IFIS) requiring additional maneuvers Audit Warning: Upcoding from 66984 to 66982 without documented complexity factors is one of the most common ophthalmology audit triggers

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