Ophthalmology and Optometry Coding Alert
PLI Is Typically An Out-of-Pocket Expense
Question: We have a patient getting cataract surgery who will require a premium lens implant. How will we determine what the patient will have to pay for the surgery and the implant? Codify Subscriber Answer: When you perform cataract surgeries with premium lens implants (PLIs), the PLI will be considered an out-of-pocket expense because the cataract surgery itself is covered by Medicare and the lens is not. You should calculate the patient’s portion of the cataract surgery (after deductibles, co-pay, etc.), and then add the PLI charge to that to determine what the patient’s out-of-pocket fee will be. Some practices will request that portion of the payment from the patient up-front, or before leaving the surgical suite on the day of service. That way, you can ensure that the patient will reimburse you for the noncovered portion of the charge as well as the patient responsibility portion.
Related Articles
Ophthalmology and Optometry Coding Alert
- ICD-10-CM:
You'll Find New Myopia, Blindness Codes on Oct. 1
CMS has released the finalized list of 2018 diagnosis codes. Eye care coders hoping for [...] - Breaking:
For These Eye Procedures, Report 99024 for Postop Visits
Certain states now require this new procedure. If you’re used to including post-operative visits in [...] - Modifiers:
Modifier 25 Misuse Leads to Six-Figure Settlement for This Ophthalmologist
At issue: Whether to report intravitreal injections with E/M services. Some eye care practices are [...] - Billing:
Collect More Reimbursement by Correcting This Big Issue
Following up on your claims is just as important as submitting them. As ophthalmologists face [...] - You Be the Coder:
Know How to Bill E/M Visits When the Patient Isn't Present
Question: We had a patient’s son present to talk about his mother’s glaucoma, the implications if [...] - Reader Question:
Know the New Taxonomy Subspecialty Codes
Question: When can we start using the new retina and glaucoma taxonomy specialty designations? Codify Subscriber [...] - Reader Question:
PLI Is Typically An Out-of-Pocket Expense
Question: We have a patient getting cataract surgery who will require a premium lens implant. How [...]
