Ophthalmology and Optometry Coding Alert

To prove medical necessity, you must get specific -- or risk denials

Medicare covers IOL calculation procedures for patients about to undergo cataract surgery. But just listing 366.x (Cataract) as your diagnosis code is likely to get your claim rejected.
 
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 complication of prosthetic device; due to ocular lens prosthesis
 
• V43.1 -- Lens replaced by other means.