coding q & a
New Issues with DMERCs
Learn the latest codes and qualifiers as
they relate to several items.
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
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
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
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
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.
- V2761: mirror coating
- V2762: polarization
- V2756: eyeglass cases
- V2786: specialty occupational multi-focal
- V2797: vision supply, accessory and/or service
component of another HCPCS vision code.
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
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