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Doc/Coding tips

Glasses after Cataract Surgery (DME Glasses Claims)
Posted: March 13, 2018

  • Only one pair of glasses is allowed per surgery. If each eye is done individually, you are allowed to bill one pair of glasses after each surgery for the patient. This is only applicable if the glasses are ordered and picked up prior to the second surgery being performed. (the pick-up date matters as that is the date that needs to be used for DOS on the claim)
  • An ABN needs to be signed for all non-covered lens material and any frame overage.
  • A proof of delivery needs to be signed when the patient picks up the glasses. Medicare requires you to get a signed proof of delivery from the patient. You need an itemized statement of some sort with the patient’s signature and date to prove that you did deliver the glasses as your claim states.
  • You are required to give the patient a copy of Medicare’s Supplier Standards when providing Medicare-covered eyeglasses. If you do not have a current copy, you can download it from the Durable Medical Equipment Regional Carrier Web site.

Key billing tips

  • The place of service should be changed from 11 to 12
  • The date of surgery should be listed in box 19
  • The referring physician (box 17) should be the name of the doctor giving the final Rx, not the surgeon.
  • The date of service should be when the glasses are dispensed, not ordered.
  • Frame: You will need to have two frame codes
    • V2020 – Medicare allowable amount
    • V2025 – Overage from Medicare allowable amount and frame price, this is 100% patient responsibility.
  • Lenses:
    • You will need to specify the type of lens you are using: single, bifocal, or trifocal. For optimal payment you will need to code the lenses individually, as one or both may have a cylinder, which may be different per eye. Coding with the cylinder will result in higher reimbursement.
    • You will need to use a RT or LT modifier on the lenses and any additional add-ons to the lenses (ie. Tint, polycarbonate, etc)

Use the GA for when a patient has a signed ABN for the add on and for the additional frame cost.

Use GY if there is no ABN signed, this means you cannot collect this from the patient.

Use EY modifier on all additional lens options that are NOT prescribed by the referring physician. Use lens modifiers in this order when applicable. : EY, GA, RT, LT




  


  


  


  

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Updates Prior to 2018