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Ophthalmology and Optometry Coding Alert

Arm Yourself With NEMB for Extra Intraocular Cost

Published on Mon Sep 05, 2005

Leave the ABNs aside for P-C IOLs and other Medicare noncovered services

You may think getting your patients to sign an advance beneficiary notice is playing it safe. But an ABN is not always the best idea--especially when dealing with a benefit that you know Medicare never covers, like Crystalens or RESTOR lenses for cataract patients.

Because Medicare does not reimburse for the presbyopia-correcting functionality of a presbyopia-correcting intraocular lens (P-C IOL), "the facility and physician are not required to provide an advance beneficiary notice to beneficiaries who request a presbyopia-correcting IOL," says the August change request.
 
When Medicare never covers a service for any reason, it is never appropriate to request a patient to sign an ABN.
 
"An ABN would not apply because we're not billing [the extra services] to Medicare," says Kim Ford, coding manager for Campanella and Pearah Eye Care Associates in Sinking Spring, Pa. She does, however, recommend a Notice of Exclusion from Medicare Benefits (NEMB). "We've just started having our Medicare patients who want the RESTOR or Crystalens sign that," she says.

Medicare agrees: An Aug. 5 program transmittal strongly encourages practices to issue an NEMB to prospective P-C IOL patients "in order to clearly identify the non-payable aspects of a presbyopia-correcting IOL insertion."

You can download an English NEMB form at http://cms.hhs.gov/medicare/bni/20007_English.pdf.   For a NEMB in Spanish, go online to http://cms.hhs.gov/medicare/bni/20007_Spanish.pdf.

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