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Ophthalmology and Optometry Coding Alert

Reader Questions:

Prove Necessity for Large Bifocal Segs

Published on Wed Sep 01, 2010

Question: I'm really confused about HCPCS codes V2219 and V2319 for Medicare patients. I know it's an add-on code, but what kind of documentation do we need to prove medical necessity? I have a new optician who disagrees with the way we bill those two codes -- he insists that the prescription needs to specifically state that a segment greater than 28 mm is necessary for Medicare to pay. Texas SubscriberAnswer: You should not need any additional documentation for V2219 (Bifocal seg width over 28mm) or V2319 (Trifocal seg width over 28mm) beyond what you need for refractive lenses in general. Medicare durable medical equipment regional carriers (DMERC) will not reimburse for refractive lenses unless the patient has had cataract surgery or who have congenital absence of lens.The ICD-9 code that proves medical necessity must be included on the claim. Cigna, the DMERC for Region C, which includes Texas, lists 379.31 [...]
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