Also, Anticipating extra pay for new-technology intraocular lenses? Read this medical billing and coding article first.
Cataract surgeries are a routine part of a lot of ophthalmologic surgery practices, and intraocular lens (IOL) insertion is a routine part of a lot of cataract surgeries. However a new generation of multifocal IOLs is altering the routine - both for the surgeon as well as the coder. To get reimbursement, you'll need to keep your HCPCS manual handy. This expert medical billing and coding article will tell you how.
Background: Next to cataract surgery, in which the surgeon gets rid of the patient's natural lens, Medicare will pay for the insertion of a novel standard (monofocal) IOL. In case the surgery takes place in the office, you must assign HCPCS code V2632 (Posterior chamber intraocular lens) to cover the cost of the standard IOL.
Exception: Code V2632 does not cover the added cost of a multifocal IOL, which not only replaces the natural lens however also corrects refractive errors – for instance an astigmatism-correcting (A-C, also known as "toric") or presbyopia-correcting (P-C) IOL.
P-C IOLs go further than the function of a standard IOL by correcting presbyopia, the incapability to focus on near objects. An A-C IOL fixes astigmatism, an irregular curvature of the cornea.
Medical Billing and Coding Update: Turn to HCPCS Codes for Full Payment
Patients may be given the non-covered lens as well as physicians are recommended to counsel the patient that the cost will be their accountability. Collect the cost up-front or have the patient sign a financial responsibility agreement. Although Medicare will not pay for the additional cost of an A-C or P-C IOL, it is a correct medical billing and coding practice to bill the patient for the dissimilarity, using two HCPCS codes:
A-C IOLs: You must report V2787 (Astigmatism correcting function of intraocular lens). Medicare recognizes these as A-C IOLs:
P-C IOLs: Report V2788 (Presbyopia correcting function of intraocular lens) Medicare recognizes these P-C IOLs:AcrySof ReSTORAcrySof IQ ReSTORCrystalensReZoomTecnis Multifocal Acrylic Intraocular LensTecnis Multifocal 1-Piece Intraocular LensTecnis Silicone Intraocular Lens.
No More New Technology IOL Reimbursement
Remember, you should not confuse A-C and P-C IOLs with novel technology IOLs (NTIOLs) to make certain that you achieve medical billing and coding accuracy. NTIOLs are a different category of IOLs that reduce corneal spherical aberrations. Medicare identifies them as having definite clinical advantages as well as dominance over existing IOLs with regard to lesser risk of postoperative complication or trauma, enhanced postoperative recovery, lesser induced astigmatism, enhanced postoperative visual acuity, more stable postoperative vision, or other similar clinical advantages. Get free and comprehensive medical information and advice today at this medical advice website, source.