Ophthalmology and Optometry Coding Alert

Question: Our office often provides eyeglasses to patients after cataract surgery. We-ve been told a DMERC inspector could audit us, and we-re not sure what information we need to have on hand to pass an audit. Can you give us a list?


Florida Subscriber
Answer: A Medicare patient is entitled to one standard pair of glasses after each cataract surgery with an IOL implant. If you have an on-site audit, the DMERC inspector may ask you to produce the following forms for patients who receive post-cataract eyeglasses:

- The new eyeglass prescription, written after the surgery.

- An assignment of benefits (AOB), usually called a -signature on file,- if your office has accepted the assignment.

- An advance beneficiary notice (ABN) if the glasses have any special features such as deluxe frames or progressive addition lenses (PAL).

- A deluxe frame or deluxe lens form if the patient received either or both.

- Proof of delivery (POD), such as a receipt for the dispensed glasses, signed and dated by the patient.

- The supplier standards form. If you are not sure if the patient has already used his once-per-surgery eyeglasses benefit, you should have him read and sign an ABN, clarifying that he will be responsible for any part of your fee that Medicare does not cover.

Best bet: Append modifier GA (Waiver of liability statement on file) to the codes for the lenses and frames that you submit to the DMERC carrier. If Medicare does deny the claim because its records show that the patient has already received his post-cataract glasses, the patient will be financially responsible to you for the cost.