Ophthalmology and Optometry Coding Alert

Medicare has announced that it will cover 66982 (extracapsular cataract removal with insertion of intraocular lens proshesis...) in ambulatory surgical center (ASC) facility fees retroactive to Jan. 1, 2001. Ophthalmologists may have performed 66982 in an ASC since January but not known how to bill the facility fee. Previously, the facility fee could be billed and covered under 66984, according to HCFA. Now, you may use 66982 for the ASC facility, under payment group 8. The effective date for the program memorandum is July 1, and the implementation date is Oct. 1. 

Note: Effective dates are the dates that the policy becomes official. Implementation dates are the dates by which the carrier must be in full compliance with the policy. A separate implementation deadline is sometimes set when there is reason to believe carriers may need additional time to comply. 

It may take several months for local carriers to load the new ASC rates into their claims production environment, so they may choose one of the following interim options, according to program memorandum transmittal AB-01-81 (change request 1670), dated May 15, 2001:

Option 1: They may hold claims until their carrier installs the updated ASC facility rates and new wage indexes. They may split claims during this period. If applicable, they must pay interest on clean ASC claims that are delayed beyond statutory claims-processing timeliness standards.

Option 2: They may process ASC claims for any 66984 procedures provided on or after Jan. 1, using last year's rates and wage indexes. If they do this, they must adjust the ASC facility claims paid for services that were processed prior to the installation of the updated rates.

 
Physicians and hospitals started getting paid for 66982 in January, but ASCs did not. Field groups such as the American Society of Cataract and Refractive Surgery (ASCRS) have been lobbying for this change.

 
"Although HCFA's delay is regrettable, ASCs that had claims for reimbursement for CPT 66982 previously denied will be entitled to reimbursement," ASCRS says. "However, please be aware that carriers may be slow to update systems to reflect this change and that claims-processing delays and denials may be experienced." 

If you had 66982 claims denied and did not resubmit using the preprogram memorandum code (66984), then instruct your carrier to reopen the denied 66982 claims. Bear in mind that Medicare carriers are not obligated to reopen denied claims without a specific request from the provider.