Ophthalmology and Optometry Coding Alert

Question: When should the charge for ultrasound biometry with IOL calculations be submitted to insurance: on the day it is done and interpreted, or on the day the cataract surgery is performed?

Lisa Finston
Beetham Eye Institute, Boston

Answer: In most Medicare carrier areas, the A-scan can be billed when it is performed; you do not have to wait until the cataract surgery. A few Medicare carriers still require that the date of surgery be entered on the claim in the note or comment field when billing for this procedure, but most do not. Check with your Medicare carrier for any unique claim filing requirements they may have.

HCFA policy even allows the A-scan to be billed for both eyes at the same time when both cataracts will be operated on within a short time frame. This is why most Medicare carriers no longer require the A-scan to be billed on the day of surgery.

Answers contributed by Lise Roberts, vice president, Health Care Compliance Strategies, Jericho, N.Y.; Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.; and Michael X. Repka, MD, American Academy of Ophthalmology representative to the CPT Advisory Committee.