As the technology for refractive surgery evolves, we are seeing a whole new segment of care for which optometrists are vital: caring for cataract or clear lens extraction patients before and after surgery.
IOL technology is constantly improving, and surgical techniques and platforms are keeping pace to deliver great outcomes for patients. With all of these changes impacting patient care, don’t forget the all-important question: what is our role in both the pre-op and post-op care and how does it affect how we code and bill for our professional services? Let’s take a look.
Be an Expert
As first-line eye care providers, we see the vast majority of patients in the United States today for routine eye care. Because of this, we are also on the front lines providing professional advice and making appropriate referrals when an IOL implantation is the best treatment choice. It is our responsibility to be familiar with the various IOL options—and the surgeons who work with the specific platform we are recommending to our patients, whether it’s a traditional monofocal IOL, or a multifocal, toric or multifocal toric lens.
Respect the Relationships
The formal transfer of care begins with the referral to a specific surgeon. After that, the patient is now formally their patient. Keep in mind that comanagement is a non-financial arrangement between a surgeon and a comanaging physician who provides care to the patient for some portion of the global follow-up period.
The comanagement portion of any surgery begins with the formal transfer of care back from the surgeon to the comanaging physician—typically to the physician who originally referred the patient for a surgical evaluation, but not always. However, the initial referral cannot be based on the requirement that the surgeon refer the patient back to the referring physician.
Most often, the patient is the one choosing the comanaging physician, so you should discuss the arrangement with your patient before the initial surgical evaluation to ensure they know to request you as their post-op care provider.
Coding Dos and Don’ts
When billing for the comanagement portion of patient care, the global period is 90 calendar days after the surgical procedure is performed. The appropriate coding for your postoperative services is described by the surgical code performed by the surgeon with the appropriate modifier appended to the code:
Traditional monofocal IOL
6698X-55-RT/LT for the first eye.
6698X-79-55-RT/LT for the second eye.
Tip: Always bill to the insurance carrier, and use the appropriate ICD-10 cataract diagnosis throughout the comanagement period.
Use the following code descriptors, in addition to the traditional monofocal codes described earlier, to bill the patient directly for the premium portion of the IOL:
Multifocal IOL. V2788: Presbyopia-correcting function of intraocular lens.
Tip: Use the ICD-10 code for presbyopia along with this code.
Toric IOL. V2787: Astigmatism-correcting function of intraocular lens.
Tip: Make sure to use the appropriate ICD-10 code for astigmatism along with this code.
Multifocal toric IOL. Follow the guidelines for a multifocal IOL as described above.
When working with premium IOLs, it is generally prudent that no money be paid from the surgeon to the comanaging physician. It is best practice to have the patient pay each entity separately for their respective portion of the care provided: one payment to the surgical center, one to the surgeon and one to the comanaging physician.
Making the right referral to the right surgeon for the best outcome is always paramount for us, and knowing the latest advances is integral to these decisions. Understanding our role in providing the very best care for our patients also helps us understand how to document the medical record and code for our services.
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