Article Date: 7/1/2003

coding q & a
Post Cataract Surgery Glasses
Watch for these common billing problems with Medicare optical claims.
By Suzanne Corcoran, C.O.E.

Q When does Medicare cover eyeglasses?

Medicare will cover up to one pair of eyeglasses after cataract surgery with implantation of an intraocular lens. Because Medicare's medical necessity requirement is applicable, the law doesn't guarantee these patients will always receive a pair of glasses following each surgery.

Q When are two pairs not covered?

If both cataract surgeries are performed within a short period of time and the patient doesn't get glasses following the first surgery, then Medicare will only cover one pair of glasses after the second surgery.

If both cataract surgeries are performed within a short period of time and the patient does get glasses following the first surgery, then he may not need a new frame. In this case, a new lens for the second eye is medically necessary. If the results of the second surgery cause the prescription in the first eye to change, then both lenses are covered.

Q What are common billing errors, and how should we file these claims?

Claims for postcataract eyeglasses are some of the most complex in all of Medicare. Here are some areas to watch out for on the CMS-1500 claim form:

Sidestep Medicare audits

If you watch out for these common pitfalls, your Medicare claims for postcataract eyeglasses will process more smoothly and you will avoid the risk of refunds in the event of a post-payment audit.

Suzanne Corcoran is vice president of Corcoran Consulting Group.  Reach her at (800) 399-6565 or at SCORCORAN@CORCORANCCG.COM.

 


Optometric Management, Issue: July 2003