ICL Procedure Code??

suzybray

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We have many patients wanting us to verify benefits for a pre-determination or actually bill their insurance for the ICL procedure. We have many patients with refractive benefits and they think their insurance might cover a portion of this procedure.

I was wondering if the procedure could be coded as 66985? Or would it be best to use 66999?

Can I only use 66985 for piggy back procedure? The patients have their natural lens and they are having the ICL inserted additionally.

For the Visian lens itself, I think, the HCPCS code would be S0596?

Thank you!
 

Cheezum51

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For a patient who still has their natural lens, I would consider the use of an ICL a purely cosmetic procedure, just as LASIK is a cosmetic procedure.

I would be reluctant to bill this to a patient's medical carrier since it doesn't meet the criteria of the code you asked about and is basically done so a patient doesn't have to wear glasses. The carrier could consider billing this as either a fraud or abuse billing in my humble opinion.

Tom Cheezum, O.D., CPC
 
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