Ophthalmology and Optometry Coding Alert

You’ve got a little more work to do if your cataract patient wants more than the typical intraocular lens implant.

As we noted in a previous issue (see “Simple Solutions for Complex Cataract Coding” in Ophthalmology Coding Alert Vol. 17, No. 7), cataracts affect more than half of Americans 80 and older, so your practice is probably seeing a fair share of cataract cases. And along with those cases, your practice is dealing with the intricacies of coding and billing for the intraocular lenses that the ocular surgeon replaces during the course of the surgery.

The regular IOL insertion is included in the cataract surgery — but what happens when the patient requests a presbyopia-correcting (P-C) or astigmatism-correcting (A-C) IOL? 

Background: A conventional IOL is covered when implanted during cataract surgery, says Medicare. “A conventional IOL is a small, lightweight, clear disk that replaces the distance focusing power of the eye’s natural crystalline lens,” as Medicare states in its “Medicare Vision Services Fact Sheet.” 

If the surgery takes place in the office, assign HCPCS code V2632 (Posterior chamber intraocular lens) to cover the cost of the standard IOL.

“Medicare specifically excludes certain items and services from coverage, including eyeglasses and contact lenses. Congress, however, has provided an exception for one pair of eyeglasses or contact lenses covered as a prosthetic device furnished after each cataract surgery with insertion of an IOL.”

Medicare will pay for these benefits:

• A conventional IOL implanted following cataract surgery;
• Facility and physician services, and supplies required to insert a conventional IOL following cataract surgery;
• One pair of eyeglasses or contact lenses as a prosthetic device furnished after each cataract surgery with insertion of an IOL.

Code V2632 does not cover the additional cost of a multifocal IOL, which not only replaces the natural lens but also corrects refractive errors — such as an astigmatism-correcting (A-C, also known as “toric”) or presbyopia-correcting (P-C) IOL. 

P-C IOLs go beyond the function of a standard IOL by correcting presbyopia, the inability to focus on near objects. An A-C IOL corrects astigmatism, an irregular curvature of the cornea. A-C IOLs are also known as “toric” IOLs.

Rationale: “A single P-C IOL or A-C IOL essentially provides what is otherwise achieved by two separate items: an implantable conventional IOL (one that is not presbyopia- or astigmatism-correcting), and refractive correction similar to the correction provided by refractive surgery, eyeglasses or contact lenses,” says Medicare.

Medicare has, however, provided two HCPCS codes to represent the extra cost of a P-C or A-C IOL:

• V2787 (Astigmatism correcting function of intraocular lens)
• V2788 (Presbyopia correcting function of intraocular lens).

The toric lenses are an average of about $1,100 per eye and P-C lenses can be up to $2,500 per eye, notes Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, AHIMA-approved ICD-10 CM/PCS trainer and president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla.

Example: After cataract surgery, a patient receives a presbyopia-correcting IOL. The cost of a normal IOL is $150, and a P-C IOL costs $2,500. Code the supplies as:

• V2632 x 1, $150
• V2788-GY x 1, $2,350.

Medicare maintains a list of lenses it recognizes as P-C or A-C IOLs. 

P-C IOLs

• Crystalens (Bausch & Lomb)
• AcrySof ReSTOR (Alcon Laboratories)
• ReZoom (Advanced Medical Optics)
• AcrySof IQ ReSTOR, models SN6AD1, SN6AD3, MN6AD1, MN60D3 (Alcon Laboratories)
• Tecnis Multifocal Acrylic Intraocular Lens, model ZMA00 (Abbott Medical Optics)
• Tecnis Multifocal 1-Piece Intraocular Lens, model ZMB00 (Abbott Medical Optics)
• Tecnis Silicone Intraocular Lens, model ZM900 (Abbott Medical Optics)
• A-C IOLs
• Acrysof Toric IOL, models SN60T3, SN60T4, SN60T5 (Alcon Laboratories)
• Acrysof Toric IQ IOL, SN6ATT models (Alcon Laboratories)
• Silicone 1P Toric IOL, models AA4203TF, AA4303TL (STAAR Surgical)
• Tecnis Toric 1-Piece IOL, models ZCT150, ZCT225, ZCT300, ZCT400 (Abbott Medical Optics)
• Trulign Toric Posterior Chamber Lens, models AT50T, BL1AT, BL1UT (Bausch & Lomb)

Medicare will periodically update the list; the most current list can be found at www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment.