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Topic: Improve coding ophthalmology at your ASC (part two)

Ambulatory Surgery Reimbursement Update, May 20, 2008

Coders should be on the lookout for reimbursement opportunities that they might typically miss when coding ophthalmology procedures. For example, ASCs sometimes miss billing for vitrectomy, which is bundled with cataract surgery but not with IOL exchange or secondary implant, says Kevin J. Corcoran, COE, CPC, FNAO, president of Corcoran Consulting Group in San Bernardino, CA.

Also, physicians may combine limbal relaxing incisions (LRI), which is performed to treat astigmatism, with cataract surgery. However, ASCs might miss charging for LRI, Corcoran says.

Medicare generally does not cover LRI, but ASCs can and should bill the patient for this service. As with all procedures not covered by insurance, ensure that your front office staff presents your patients with the appropriate financial agreement in advance of the procedure stating that the patient will need to pay for it.

Note: Medicare covers LRI in rare cases of surgically induced astigmatism that a patient cannot ameliorate with eyeglasses or contact lenses. Medicare coverage is premised on treating a surgical complication.

ASC billers also sometimes miss reporting tissue acquisition for a Descemet’s Stripping Endothelial Keratoplasty corneal transplant, says Joyce Jones, CPC, CPC-H, CCS-P, CPC-ASC, director of business operations at AMSURG in Nashville. Processing the tissue can cost the facility as much as $2,000–$3,000. Facilities should bill for the procedure and the supply (using code V2785) on the same claim. However, coders should not report modifiers on the supply code, Jones says.

Editor’s note: This topic is from the May 2008 issue of Ambulatory Surgery Coding & Reimbursement Insider.

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