Advanced Search

Ophthalmology and Optometry Coding Alert

Reader Question:

Note Refraction Exclusion to Clarify ABN Confusion

Published on Sat Oct 10, 2009

Question: Are patients undergoing keratoconus workup or contact lens fitting still required to sign an advance beneficiary notice (ABN)? Why is it necessary when Medicare won't pay for it anyway? Nebraska Subscriber Answer: According to CMS, "ABNs are not required for care that is either statutorily excluded from coverage under Medicare (i.e., care that is never covered) or fails to meet a technical benefit requirement (i.e. lacks required certification)." You are correct that contact lens fitting (92310, Prescription of optical and physical characteristics of and fitting of contact lenses, with medical supervision of adaptation; corneal lens, both eyes, except for aphakia) is never a covered service by Medicare. Therefore, you are not required to obtain the ABN, but you may want to consider voluntarily doing this as a means of notifying the patient of non-coverage and financial responsibility. You are also not required to submit the non-covered service to Medicare [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Ophthalmology and Optometry Coding Alert

View All