Wiki IOL Exchange

[cindykae@charter.net]

Have a patient that after her first cataract surgery, she decided that she wanted far sightedness for her second surgery as opposed to near sightedness at the cataract evaluation exam. She is being co-managed by an OD that is outside our practice. That message of the lens change wasn't communicated to the surgeon before her second surgery and the IOL on the second eye is for near sightedness. The patient is unhappy and wants an IOL exchange. The surgeon is wanting to use the dx code T85.29XA Other mechanical complication of intraocular lens. I disagree as there is no mechanical complication of the lens, the wrong lens was implanted. I told the surgeon that wasn't a mechanical complication of the IOL but I'm getting some pushback from him and just wanted to verify that I was correct. This sounds more like a refractive error dx that wouldn't support the medical necessity for an IOL exchange. Should the dx be T85.29XA?

 

[CBLENNIE]

Is your surgeon planning to bill this procedure to the patient's insurance company? I work for an insurance company, and we would question the medical necessity of this procedure and if the records were to show the procedure was done because the incorrect IOL was placed in the original surgery, the claim would likely be denied.