Optometry Coding & Billing Alert

Published on Tue Dec 25, 2012 PDF

If your optometry practice treats patients after they have had cataract surgery, you could very well be providing glasses for them.

Good idea: Make sure to document the following for any post-op cataract care patient who gets glasses from your optometrist:

- 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.

Remember: A Medicare patient is entitled to one standard pair of glasses after each cataract surgery with an IOL implant. 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 advance beneficiary notice (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 denies the claim because its records show that the patient has already received his post-cataract glasses, the patient will be financially responsible for the cost.