Cataract extraction with insertion of Premium IOL

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Brooklyn, NY
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I'm an Ophthalmology coder and I was asked by my one of the physicians if there is a code for just the insertion of the premium IOL ,during the Cataract procedure. I explained to the MD that there is no separate code for insertion of premium lens , since 66985 is bundled with the Cataract code (66984 or 66982) . I have been billing the cataract extraction with the proper code,along with V2787 or V2788 for the premium lens.

The MD explained to me that the insertion of the premium lens is more complex than the standard lens and they should be reimbursed for it. I suggested to create an internal code for the insertion of the premium lens and have the pt. sign an ABN.

I should also mention that I do remote coding and the hospital that I bill for these cases, bill in the same manner as I do at my current position - 66982 or 66982 with the V code for the premium lens.

I would like some feedback from my fellow Ophthalmology coders how do they normally bill for this scenario.
 

Cheezum51

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You are coding things correctly, as you know. Just because a patient has opted for a premium IOL doesn't make the surgery complex and if the surgeon wants you to bill for a complex surgery just because they're using a premium IOL, I would consider that an "abuse/fraud" situation.

The patients are all charged a very significant extra fee for any premium IOLs by the surgeons in my area and that extra fee should include any additional complexity involved in inserting the IOL into the eye. If your surgeon feels he should be paid more for the "complexity" of inserting the premium IOL, then he should increase his fee, paid out of pocket by the patient, accordingly.

Just my opinion but I think it's appropriate for what you've stated here.

Tom Cheezum, O.D., CPC
 
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