Ophthalmology and Optometry Coding Alert

Powerfully Document Necessity For IOL Power Calculations

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.
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