Cataract Lens Coding

kschulte71

Networker
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Need clarification on this please.
Patient comes in for cataract surgery. We bill 66984 procedure code, C1783 for and V2632 for Lens. Everything I read says not to put the V2632 if we bill 66984 as it is included in the reimbursement. However, Medicare is paying for all 3 charges. Which is correct in this scenario?

Also, we have a patient that the physician is going to use the a symfony toric lens. it is not paid by Medicare. They are billing the V2632 AND the V2787 to Medicare. The V2632 is paying but the V2787 is not. The patient is being held liable for this charge. Should we be billing both codes or just the V2787 to the patient?
 

Cheezum51

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You shouldn't be billing both IOL codes. All you need to bill is the 66984 for the surgery and the post op care and then bill the V2787 with the eye modifier (LT or RT). Medicare should pay the full fee for the 66984 and they will pay the maximum allowable fee they would pay for a standard IOL with the patient being responsible for the balance for the toric IOL.

Medicare never pays for specialty IOLs (toric or multifocal etc) and the patient is always responsible for the difference between what Medicare pays for the standard spherical IOL and the fee you charge for the specialty lens. You need to have the patient sign the appropriate forms acknowledging that they are responsible for the additional fee for the specialty IOL.

Tom Cheezum, OD, CPC, COPC
 
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