Outpatient Surgery Magazine

Marking Madness - April 2013 - Subscribe

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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Page 37 of 157

OSM560-April_DIGITAL_Layout 1 4/5/13 2:28 PM Page 38 CODING & BILLING of the cataract CPT code. You must subtract that amount from the amount you charge the patient for the premium lens. Medicare allows you only a modest markup of $25 to $50 above the IOL cost for handling on premium IOLs. We break down the math on the preceding page. Setting patients straight If you want to indicate on your Medicare claim form that you used a premium IOL in the cataract procedure, bill the premium lenses using code V2787 for a toric astigmatism-correcting lens or code V2788 for presbyopia-correcting IOLs (CrystaLens, ReSTOR and ReZoom) with the –GY Non-Covered Modifier and/or the –GA Modifier appended to the V-code to indicate the patient has signed an Advanced Beneficiary Notice (ABN form or waiver). Because Medicare never covers the premium IOLs, you don't have to have Medicare patients sign an ABN. Still, it's a good idea to have them do so. This way, there'll be no misunderstandings with patients on what they'll owe you for these lenses. It's also a good idea to check out your internal policy on the use of premium lenses in your cataract cases and make sure that you and your cataract surgeons won't get in trouble on this issue with Medicare. OSM Ms. Ellis (sellis@ellismedical.com) is president of Ellis Medical Consulting, a healthcare consulting firm in Nashville, Tenn. 3 8 | O U T PAT I E N T S U R G E R Y M A G A Z I N E | A P R I L 2 013

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