Ophthalmology and Optometry Coding Alert

Under a much-anticipated exemption to the Stark II referral ban, ophthalmologists will be able to self-refer for postcataract eyewear.

Just before he left office, President Clinton signed an executive order implementing Stark II, which includes an exemption for ophthalmologists. For six years, ophthalmologists have fought for this. The final regulation, released in January 2001 by the Department of Health and Human Services, includes an exemption for dispensing eyeglasses after cataract surgery. Under the final rule, an ophthalmologist can refer a Medicare patient to an optical shop owned by the ophthalmologist for postcataract eyewear.

In addition, the final rule includes substantial relief for the direct-supervision requirement. Previously, the rule defined direct supervision strictly: The ophthalmologist had to be present when the glasses were furnished. This would have closed many ophthalmologist-owned optical shops.

Although it is a moot point because postcataract glasses are now exempt from Stark II, ophthalmologists no longer need to be present in their optical shops.

Stark II also allows ophthalmologists and other physicians to refer patients to ambulatory surgical centers (ASC) that they own. Intraocular lenses (IOL) and other prosthetic devices, when implanted in an ASC by the referring ophthalmologist, are also exempt from Stark II. HCFAs reasoning is blunt: Not to have exempted prosthetic devices would have meant that these procedures would have been performed in hospital outpatient settings, at considerably higher cost than in ASCs.

Note: Medicare covers eyewear only for cataract surgery patients who are pseudophakic, once per lifetime per operated eye, or aphakic, no more than once per year as medically necessary.