Ophthalmology and Optometry Coding Alert

Keep medical necessity distinct from patient preference in documentation. If you're providing refractive lenses for cataract surgery patients, you'll need to unravel your DME MAC's complex coding and billing rules to claim deserved Medicare reimbursement. The challenge: Ophthalmology coders often describe durable medical equipment (DME) coding and billing as one of the most complex duties they perform. Coding for refractive lenses makes it even more complex, with the multitude of options available to patients combined with Medicare's strict coverage guidelines. Medicare will only pay for refractive lenses for aphakic beneficiaries (patients who are lacking the organic lens of the eye due to surgical removal, e.g., after cataract surgery, or who have congenital absence). Medicare covers one complete pair of glasses or contact lenses after each cataract surgery with insertion of an artificial intraocular lens, notes Joyce D. Ardrey, CPC, an ophthalmic coding consultant in Tulsa, Okla. Append KX for Doctor-Ordered [...]