CODINGFORCATARACTSURGERY WITH INTROCULARLENSES

Since V2787 and V2788 are statutorily non-covered, Medicare will adjudicate the charge for those HCPCSto patient liability The hospital should append a modifier GYto V2787 or V2788 to ensure that portion of the lens charge drops to patient liability Medicare adjudicated the example claim shown above as follows ? note the ?Non-Covered?column, which will drop to patient liability:

Many hospitals bill vision correcting IOLs incorrectly. Some hospitals bill the entire charge for a vision correcting IOLs on one line with V2787 or V2788, and the entire charge is assigned to patient liability.

That practice is non-compliant ? and unfairly shifts a greater portion of the charge to the patient. OPPShospitals should always report the conventional IOL when billing for cataract surgery with a vision correcting lens

When Medicare undertakes rate-setting for total APCreimbursement, a portion of the reimbursement is attributed to the cost of the covered implant By failing to report the conventional lens cost, Medicare?s OPPSrate-setting data from claims will have less cost attributed to the covered IOL

In 2023, Medicare OPPSfiles indicate that only 67.5%of all claims for CPT® 66984 also reported the conventional lens charge V2632 on the same claim Since not all claims for 66984 reported a covered lens charge, we might surmise that the APCrate understated the implant cost by as much as 32.5%. Here?s an excerpt from the 2023 OPPSAddendum P showing the portion of the total APCpayment that is attributed, through rate-setting analysis, to the IOL:

Codingforcataractsurgery With Introcularlenses

If all hospitals had reported the conventional IOL as appropriate, the total APC reimbursement might have been higher The cost of a non-covered vision-correcting lens is not included in the APCrate-setting process.

Incidentally, some hospitals confuse a vision-correcting IOL with a ?New Technology IOL? (NTIOL) ? these are two different things. HCPCSC1780 ? LENS, INTRAOCULAR(NEW TECHNOLOGY) is covered, but it is inaccurate There are no Medicare-approved NTIOLs Here?s the CMSwebsite that makes this clear, and also provides a download of the approved vision-correcting IOLs: https://www cms gov/Medicare/Medicare-Fee-for-Service-Payment/ASCPayment/NTIOLs

Finally, most hospitals have a policy that the incremental cost of a vision-correcting lens must be paid by the patient/guarantor in full prior to the eye surgery.

Two new tools have recently been added to the Advisor tab in the PDE. Crosswalks to the appropriate HCPCS codes for radiologic contrast materials and radiopharmaceuticals and their corresponding CPT codes are now available

The crosswalks also provide information about the types of studies for which each drug is used, the associated NDCs, suggested revenue codes, CCI edits, MUEs, and more

In most cases, submitting charges for contrast and radiopharmaceuticals will not result in additional Medicare reimbursement for an OPPSfacility (Critical Access Hospitals are paid on a cost-reimbursement basis by Medicare.) However, it is still important to report the charge for the contrast agent or radiopharmaceutical for two reasons:

- Medicare bases APCreimbursement on cost data collected from hospital claims, and

- Some payers (like Medicaid) will reimburse contrast separately

Clients can access these tools via the Advisor Tab in the PDE:

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According to an MLN Fact Sheet published in December, 2022, Medicare will require all 340(B) entities, including Critical Access Hospitals, which submit claims for separately payable Part B drugs and biologicals to report modifier ?JG?or ?TB?on claim lines for drugs acquired through the 340(B) discount program.

The MLN is available at the following website: www cms gov/files/document/mln4800856-medicare-part-b-inflation-rebate-guidance-use340b-modifier pdf