Ophthalmology and Optometry Coding Alert

Question: A patient undergoing complex cataract surgery received an astigmatism-correcting IOL. Which code should we report for this?

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Answer: Actually, every cataract procedure already includes the insertion of an intraocular lens prosthesis. Therefore, CPT® code 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [1- stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or phacoemulsification], complex, requiring devices or techniques not generally used in routine cataract surgery [e.g., iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis] or performed on patients in the amblyogenic developmental stage) covers the complex cataract procedure that your physician performed.

If the procedure is performed in a facility setting, you would not be able to code separately for the lens supply. However, in an office setting, Medicare allows you to report V2632 (Posterior chamber intraocular lens) for a conventional IOL.

However:  With V2632, Medicare only covers part of the cost of an astigmatism-correcting IOL (AC-IOL, also known as a toric IOL). For the additional cost, you would use HCPCS code V2787 (Astigmatism correcting function of intraocular lens).

If the patient received a presbyopia-correcting IOL (PC-IOL), you would use HCPCS code V2788 (Presbyopia correcting function of intraocular lens).

Medicare will not pay the extra cost, so the responsibility for payment for V2787 or V2788 will ultimately fall to the patient. That’s because “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.

Reporting V2787 or V2788 to Medicare is optional. The patient may ask you to do so in order to receive a denial that he can then show to a secondary payer to receive payment. In that case, append modifier GY (Item or service statutorily excluded, does not meet the definition of any Medicare benefit or for non-Medicare insurers, is not a contract benefit) to the V code.