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Confused about IOL'S

  1. Default Confused about IOL'S
    Medical Coding Books
    I am alittle confused about IOL charges. Most insurances include IOL's in the facility fee. Astigmatism and Presbyopia correcting function of IOL's are not covered by Medicare. My question would be how are you billing for these types of IOL? Are you having the patient sign an NEMB? Are you submitting Q1003 (MC) and V2787/V2788 to the insurance then billing the patient once denied? Any suggestions would be appreciated. Thank you!

    Kelly Sumansky, MA, CPC-H, CMC

  2. #2
    Location
    Jacksonville Beach, FL
    Posts
    71
    Default
    We do it a bit different because the patient pays the surgeon for the lens and then we bill the surgeon. I do bill the V code with a modifier GY to medicare. Other insurances may cover these lenses depending on your contract. Hope this helps.
    AWest

  3. #3
    Default
    My understanding is that Q1003 is for NTIOLS (New technology) CMS has a list on website of the lens that are approved and CMS allows an extra $50.00.

    P-C IOLS we bill with V2788 and A-C IOLS we used V2787 both with GY modifier. We collect up front from the patient the extra cost of the lens and have them sign NEMB.

  4. Default
    --------------------------------------------------------------------------------

    Q1003 is for NTIOLS (New technology) CMS has a list on website of the lens that are approved and CMS allows an extra $50.00 (common one our facility uses AcrySof IQ SN60WF)

    Our facility:P-C IOLS we bill with V2788 (common one we use SA60D3 Restor)
    A-C IOLS we used V2787 (examples: SN60T3, SN60T4, SN60T5 by Alcon,
    AA4203TF, AA4203Tl and AA4203TL by STAAR surgical) both with GY modifier. We collect up front from the patient the extra cost of the lens and have them sign NEMB.

  5. Default Link of IOL supply codes
    I am new to learning ASC coding. Could I please get the link you all are referring to for (with ease) pulling up the CMS list for
    a) supplies that are covered
    b) IOL billing
    c) Drugs ( HCPCS J-codes) that are covered

    I tried but cannot seem to find a list I can pull up easily and quickly
    while doing.
    Thanks for help
    roshrom

  6. #6
    Location
    NEW ORLEANS
    Posts
    954
    Default
    Why do you use GY modifer if you already collected fee from patient . Why summit it?

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