Surgical Correction of Corneal Astigmatism

Ophthalmologists have a variety of options available to them for the management of astigmatism.  These include spectacles, hard or soft contact lenses, and a variety of surgical procedures.  The surgical procedures for correction of corneal astigmatism (SCOCA) include limbal relaxing incisions (LRI), corneal relaxing incisions (CRI), astigmatic keratotomy (AK) and photorefractive keratectomy (PRK) or LASIK procedures.

Astigmatism may be either pre-existing or iatrogenic (e.g., induced by the effects of treatment, usually surgery).  Medicare covers refractive surgery in the rare instances when it is performed to correct a surgical complication or trauma.  Surgically induced astigmatism may be covered; treatment of pre-existing astigmatism is considered refractive surgery and is non-covered.

The mere existence of iatrogenic astigmatism does not automatically make astigmatic correction a covered service.  As with all elective surgeries, patient lifestyle complaints, along with trial and failure of prior treatment, need to be well documented in the patient record.  Examples of patient complaints include: monocular diplopia interfering with driving and reading, or unable to wear contact lens due to poor comfort.  The clinical notes would include discussion regarding trial of spectacles, and possibly contact lenses, without success.

This FAQ addresses the following:

  1. What options are available for the correction of corneal astigmatism?
  2. Does Medicare cover surgery to correct corneal astigmatism?
  3. Does Medicare specify the amount of surgically induced astigmatism that must be present to be covered?
  4. If the payer determines that SCOCA is covered, how should the procedure be coded?
  5. Why doesn’t Medicare cover procedures to correct pre-existing astigmatism?
  6. How do we identify refractive surgical procedures for correction of pre-existing astigmatism?
  7. Are special tests required prior to surgery?
  8. Will these tests be reimbursed?

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