Wiki Cataract Lens Coding

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kschulte71

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Need clarification on this please.
Patient comes in for cataract surgery. We bill 66984 procedure code, C1783 for and V2632 for Lens. Everything I read says not to put the V2632 if we bill 66984 as it is included in the reimbursement. However, Medicare is paying for all 3 charges. Which is correct in this scenario?

Also, we have a patient that the physician is going to use the a symfony toric lens. it is not paid by Medicare. They are billing the V2632 AND the V2787 to Medicare. The V2632 is paying but the V2787 is not. The patient is being held liable for this charge. Should we be billing both codes or just the V2787 to the patient?
 
You shouldn't be billing both IOL codes. All you need to bill is the 66984 for the surgery and the post op care and then bill the V2787 with the eye modifier (LT or RT). Medicare should pay the full fee for the 66984 and they will pay the maximum allowable fee they would pay for a standard IOL with the patient being responsible for the balance for the toric IOL.

Medicare never pays for specialty IOLs (toric or multifocal etc) and the patient is always responsible for the difference between what Medicare pays for the standard spherical IOL and the fee you charge for the specialty lens. You need to have the patient sign the appropriate forms acknowledging that they are responsible for the additional fee for the specialty IOL.

Tom Cheezum, OD, CPC, COPC
 
Hi Dr. Cheezum

Im sorry im always asking you, post cataract glasses, I know the dx can vary I have those dx, I think, but the v code which are the v codes to use for those glasses I know the dx are z96.1 - pseudophakia, H27.01 aphakia and Q12.3 congenital aphakia, am I missing something but I need those v codes if you have, thak you
 
Co-manage Cataract post op care:

Do I file one claim with my units totaling the patients visit? I’ve been filing a claim after every visit, which Medicare denied. Medicare is so hard to work with, I’m always feeling as if they don’t want to help.

This is our first co-management, it’s a lot of resubmitting and phone calls... If there is any article on how to file please let me know.

Thank you!
 
I'll try to attach a couple of slides showing HCFA forms. For comanagement, your Date of Service is always the date of surgery. Make sure you have the surgeon's name in Box 17 and their NPI in 17B. Also, be sure to use the same cataract diagnosis code as the surgeon and be sure the surgeon's office is filing with the 54 modifier. Some carriers want the post op days billed differently than the example below. Here, our carrier wants you to put the date you assume post op care and the last day of the 90 day post op period put in Box 19. Some carriers don't want that and they want the total days of post op care entered as the Units in Box 24G.

Make sure you have a release of care form from the surgeon when they turn over care to you. In the example below, the surgery was done on 10/2, the surgeon saw the patient on 10/3 and turned over care as of 10/4. Even if you don't see the patient until a date after 10/4, you still were responsible for care from 10/4 so you should be paid from that date, not the first date you see the patient.

Make sure you calculate the last date for the 90 day post op period correctly. I've seen offices have claims denied because they were off on the last date for the 90 days by a day or so.

Note the addition of the 79 modifier for the second eye surgery. This shows that this is a separate surgical encounter from the first eye which was done during the 90 post op period for the first eye. If you don't use both the n79 and 55 modifiers, they'll reject the claim.

You should only file one claim for the entire post op period, not for every time you see the patient.

Tom Cheezum, OD, CPC, COPC

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