Article Date: 5/1/2004

coding q & a
New Issues with DMERCs
Learn the latest codes and qualifiers as they relate to several items.
By Suzanne Corcoran, C.O.E.

For those practices that dispense Medicare-covered postcataract eyeglasses, a number of important changes occurred in 2004 that you should know about. Remember that Medicare will cover up to one pair of eyeglasses following cataract surgery with implantation of an intraocular lens, as medically necessary. See my columns in previous issues of Optometric Management for additional information on Medicare coverage rules (visit OM's archives on its Web site, www.optometric.com).

Here's what you need to know

The following is a list of HCPCS code changes in 2004:

Polycarbonate Lenses. They have a new code, V2784. Optometrists usually order Polycarb or Trivex lenses because patients like their light weight and thinner appearance. Medicare won't consider them cosmetic, and therefore the patient pays most of the time. Use modifier EY on the claim to indicate that the doctor didn't order the lenses as medically necessary.

An exception occurs when you include specific medical necessity documentation in the medical record (e.g., patient is blind in one eye). In that case, submit the claim with modifier KX (specific medical necessity documentation is on file).

Tints. A new code, V2745, now describes all tints except photochromic. Medicare has deleted codes V2740 through V2743. Continue to use V2744 for photochromic coatings. Use modifier EY on the claim to indicate that the doctor didn't order the tint as medically necessary.

Ultraviolet [UV] Coating. There's an interesting situation this year with UV coating. As a policy, UV coating (V2755) is covered when ordered by the doctor, without any special documentation requirements. However, the DMERCs have decided that plastic and polycarbonate lenses have inherent UV protection, so UV coating will not be separately covered for plastic lenses. UV coating on glass lenses will be separately covered when the doctor orders it.

This effectively makes UV coating a patient-pay item most of the time.

High-Index Lenses. New codes describe high-index lenses -- V2782 (index 1.54-1.65 plastic, or 1.60-1.79 glass) and V2783 (index equal to or greater than 1.66 plastic or 1.80 glass).

Lenticular Lenses. Codes V2121 (single vision), V2221 (bifocal), and V2321 (trifocal), replace the V2x16 and V2x17 codes.

For your information

A number of other new codes have popped up. However, even though the new codes exist, Medicare won't cover these items. Still, you may find the codes useful for keeping records in your office.

And don't forget EY

In addition to the new codes, remember modifier EY, which indicates that the doctor didn't order an item or feature and that you expect a denial. The patient will be responsible for payment. You'll also need the patient to sign an Advance Beneficiary Notice that itemizes the noncovered items.

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

 


Optometric Management, Issue: May 2004