Part B Insider (Multispecialty) Coding Alert

Question: After cataract surgery, an ophthalmologist inserts a Crystalens intraocular lens to correct a Medicare patient’s presbyopia. Can I code for the physician’s services and supplies?


California Subscriber

Answer: The answer is yes, but here’s an important exception that you need to keep in mind. Medicare typically covers the insertion of a conventional, clear IOL to replace the cataract-stricken lens that the ophthalmologist removes. In May 2005, Medicare ruled that cataract patients who request a presbyopia-correcting (P-C) IOL, such as the Crystalen or AcrySof RESTOR lenses, can have them--if they are willing to pay the extra cost.

Alert: On Jan. 1, HCPCS included a new supply code V2788 (Presobyia correcting function of intraocular lens) for the extra cost of a P-C IOL, but your patients are still responsible for the difference in price between the two lenses.

For a cataract surgery with a P-C IOL insertion, report one of the following to Medicare:

• 66982 (Extracapsular cataract removal with insertion of intraocular lens prosthesis …complex, requiring devices or technique not generally used in routine surgery)

• 66983 (Intracapsular cataract extraction with insertion of intraocular lens prosthesis…)

• 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis…)

Downside: Medicare only partially covers P-C IOLs, says Marco Ortiz, manager at Harvard Eye Associates in Laguna Hills, CA. Although it does consider a conventional IOL medically necessary after cataract surgery, there is “no benefit category” for the presbyopia correction itself.

Medicare does cover one pair of eyeglasses or contact lenses for each patient following cataract surgery, but presbyopia-correcting IOLs do not fall into either category, even though they may serve the same function as eyeglasses or contact lenses furnished following cataract surgery. Therefore, “the presbyopia-correcting functionality of an IOL does not fall into the benefit category and is not covered,” notes Ortiz.