Ophthalmology and Optometry Coding Alert

Powerfully Document Necessity For IOL Power Calculations

Published on Sun Jan 09, 2005

Don't let faulty diagnosis coding shortchange your claims

Medicare covers IOL calculation procedures for patients about to undergo cataract surgery. But just listing 366 (Cataract) as your diagnosis code is likely to get your claim denied.

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 complications of prosthetic device; due to ocular lens prosthesis

V43.1 - Lens replaced by other means
Correction:
Navigate the Fee Schedule to Find Bilateral Surgery Indicators An article in the February 2005 Ophthalmology Coding Alert, "Coding IOL Masters and A-Scans Together? Read This First," referred to a "modifier indicator" found in the Medicare National Physician Fee Schedule Relative Value File. The correct term is "bilateral surgery indicator."

Bilateral surgery indicators, found for each CPT code in column "T" of the fee schedule database, determine how Medicare reimburses codes that are reported bilaterally.

We apologize for any confusion we may have caused.

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