Powerfully Document Necessity For IOL Power Calculations
Published on Sun Jan 09, 2005
Don't let faulty diagnosis coding shortchange your claims
Medicare covers IOL calculation procedures for patients about to undergo cataract surgery. But just listing 366 (Cataract) as your diagnosis code is likely to get your claim denied.
Below is a list of specific ICD-9 codes that most carriers recognize as demonstrating medical necessity for both 76519 (Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) and 92136 (Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation).
366.00-366.04 - Infantile, juvenile and presenile cataract
366.10 - Senile cataract, unspecified
366.11 - Pseudoexfoliation of lens capsule
366.13 - Anterior subcapsular polar senile cataract
366.14 - Posterior subcapsular polar senile cataract
366.15 - Cortical senile cataract
366.16 - Nuclear sclerosis
366.17 - Total or mature cataract
366.18 - Hypermature cataract
366.19 - Other and combined forms of senile cataract
366.20 - Traumatic cataract, unspecified
366.22 - Total traumatic cataract
366.30 - Cataracta complicata, unspecified
366.32 - Cataract in inflammatory disorders
366.33 - Cataract with neovascularization
366.34 - Cataract in degenerative disorders
366.41-366.46 - Cataract associated with other disorders
379.31-379.34 - Aphakia and other disorders of lens
743.30-743.39 - Congenital cataract and lens anomalies
996.53 - Mechanical complications of prosthetic device; due to ocular lens prosthesis
V43.1 - Lens replaced by other means
Correction:
Navigate the Fee Schedule to Find Bilateral Surgery Indicators An article in the February 2005 Ophthalmology Coding Alert, "Coding IOL Masters and A-Scans Together? Read This First," referred to a "modifier indicator" found in the Medicare National Physician Fee Schedule Relative Value File. The correct term is "bilateral surgery indicator."
Bilateral surgery indicators, found for each CPT code in column "T" of the fee schedule database, determine how Medicare reimburses codes that are reported bilaterally.
We apologize for any confusion we may have caused.