New in ASC-Opthalmology

bmcnamara

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Hi Everyone
I am new to ASC and billing for opthalmology procedures, so any help I can get would be really appreciated. Can I bill V2790, V2787 and V2788 (lenses) along with the cpt codes for cataract surgeries and will they be paid? Do these Vcodes need a revenue code when billing?
Thanks alot!
 

tgutierrez

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Okay, I'm learning by trial and error but here's what I've found out so far.

Q1003 is for New Technology (NT)IOL's (SN60WF) and are covered by Medicare. They allow $50 and pay $40. I have billed these same lenses to commercial plans with codes Q1003 & V2632 and have had VERY little if any success. Other lenses such as Crystalens (V2632 or V2788), Toric (V2787) and Restor and Rezoom (V2788) are not covered or paid by any insurances I've found so far. We bill these directly to the patient. All other lenses are included. The revenue code for IOL's is 0276 and that's what I use for commercial plans (even though they don't pay) and our Medicare goes on a 1500 form therefore a revenue code is not an issue.

V2790 is for amniotic Membrane and covered by Medicare but you need to send them the invoice. If you're an electronic biller, you can send your bill electronically and they will send you a request in the mail for the invoice.

Again, I am not an expert on this at all but this is what I've learned so far.

Good luck.
 

elenax

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Asc

When I billed on a UB-04, for instance to BCBS, I used revenue code 278 but most of my billing for this type of procedures are billed on the 1500.

Hope this helps!!:p
 

cconroycpch

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Okay, I'm learning by trial and error but here's what I've found out so far.

Q1003 is for New Technology (NT)IOL's (SN60WF) and are covered by Medicare. They allow $50 and pay $40. I have billed these same lenses to commercial plans with codes Q1003 & V2632 and have had VERY little if any success. Other lenses such as Crystalens (V2632 or V2788), Toric (V2787) and Restor and Rezoom (V2788) are not covered or paid by any insurances I've found so far. We bill these directly to the patient. All other lenses are included. The revenue code for IOL's is 0276 and that's what I use for commercial plans (even though they don't pay) and our Medicare goes on a 1500 form therefore a revenue code is not an issue.

V2790 is for amniotic Membrane and covered by Medicare but you need to send them the invoice. If you're an electronic biller, you can send your bill electronically and they will send you a request in the mail for the invoice.

Again, I am not an expert on this at all but this is what I've learned so far.

Good luck.

You should be very careful about billing patients for any lenses. The reimbursement for cataract surgery is normally inclusive of $150.00 for the lense itself. There is only one or two lenses that would allow you to collect any additional money from the patient.
 

tgutierrez

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Yes, I agree you need to be careful in what you charge to the patient. But these NTIOL's are non-covered and you are able to charge the patient the difference in the allowed for the regular IOL and the additional cost for the NTIOL. The NTIOL's are not medically necessary as they correct vision and Insruances (I'm primarily speaking about Medicare) feel the patient could correct their vision with glasses or some other external devise and therefore will not cover these lenses.

I found this information on the Medicare website although I don't know the specific area. Also, it has been backed up by information received by multiple conferences and seminars.
 
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L8699

Hi all, I work for a few different surgery centers. We have found out through the billing process that some Insurance companies will cover the IOL if you bill it under L8699 with a 278 revenue code. if you have contracts with Insurance companies, there might be a carve out for these implants, and if there isnt one, you should try and get it added.

Good luck!:)
 
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