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CODING & BILLING
are reimbursed at a Medicare national payment rate of $2,977.93.
Under the ASC payment system, the Medicare national payment rate
is $1,671.00.
The role of documentation
For the procedures we have considered, proper reimbursement for
glaucoma requires accurate and thorough documentation. For each
type of procedure, there may be 2 to 3 codes with differences based
on the patient's ocular history, devices used or surgical approaches.
Surgical landmarks such as the trabecular meshwork, Schlemm's
canal and the suprachoroidal space must be clearly identified in the
operative record for correct coding.
Especially for code 0192T Insertion of anterior segment aqueous
drainage device, without extraocular reservoir; external approach,
indications for the procedure should be clear and specific. Diagnosis
codes for the exact type and severity of the glaucoma will help in getting these claims reimbursed. Review Medicare Local Coverage
Determinations (LCDs) and private-payor contracts to verify what
constitutes medical necessity for these procedures.
The devices used for each procedure should be clearly documented
in the patient's medical record. Ideally, the surgeon should document
within the operative note the exact type of device that he implanted.
As was discussed, reimbursement for the majority of devices and
medications used in conjunction with glaucoma surgery are consid4 4
O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M A R C H 2013
