Low Vision Assessment Prior to Intraocular Telescope (VisionCare Ophthalmic Technologies)

FREQUENTLY ASKED QUESTIONS:

LOW VISION ASSESSMENT PRIOR TO INTRAOCULAR TELESCOPE

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Q  What are some considerations of the low vision specialist prior to implantation of the intraocular telescope?

A  The low vision specialist’s evaluation for suitability considers a number of issues, which include but are not limited to:  the potential for functional improvement, adequacy of the visual fields for mobility, the tolerance for image disparity between the eyes, and selection of the appropriate eye for the intraocular telescope based on a trial with an external telescope.  If the patient is deemed suitable for the Implantable Miniature Telescope™ (by Dr. Isaac Lipshitz) and agrees, then the next step is a referral to a cornea specialist for surgical evaluation.

 

Q  Does Medicare cover the initial evaluation by the low vision specialist(s)?

A  Yes, the initial evaluation of a patient’s candidacy for implantation of the intraocular telescope is a covered service within the Medicare program.  One Medicare Administrative Contractor (MAC), Palmetto GBA, issued guidance on suitable candidates.1.  They note that a patient must:

1)   Achieve at least a 5 letter improvement on the ETDRS chart with external telescope

2)   [Undergo] 2 to 4 sessions of pre-surgery training/assessment with a low-vision specialist

3)   Agree to participate in postoperative visual training with a low-vision specialist.

A second MAC, National Government Services (NGS), issued similar guidance in its Local Coverage Determination (LCD).2.

 

Q  How does the low vision specialist(s) report his services?

A  Use E/M (992xx) or eye exam (920xx) codes for the initial evaluations.  Within the Medicare system, outpatient consultation codes (9924x) are no longer accepted.

Additional reimbursement is made for medically necessary diagnostic testing such as perimetry (9208x).  Refraction (92015), an important diagnostic test, is not covered by Medicare.

 

Q  Following implantation of an intraocular telescope, does the low vision specialist(s) co-manage postoperative care?

A  No.  First, it is very unlikely that the surgeon would delegate postoperative care in these challenging cases, and co-management does not apply without that delegation.3.  Second, a low vision specialist focuses attention on “…rehabilitation services designed to improve functioning, by therapy, to improve performance of activities of daily living, including self-care and home management skills”.4.

 

1.  Palmetto GBA.  Local Coverage Article A53501.  Implantable Miniature Telescope (IMT) For Macular Degeneration.  Rev. eff. 10/01/15.  Accessed 03/17/16.

2.  National Government Services.  LCD L33584,  Implantable Miniature Telescope.  Rev. eff 01/01/16.  Accessed 03/17/16.

3.  Medicare Claims Processing Manual, Chapter 12, §40.2.  Accessed 03/17/16.

4.  CMS.  Transmittal AB-02-078.  May 29, 2002.  Accessed 03/17/16.

 

Provided Courtesy of VisionCare Ophthalmic Technologies, Inc.  (888) 999-4134

 

Last updated March 29, 2016

 

The reader is strongly encouraged to review federal and state laws, regulations, code sets (including ICD-9 and ICD-10), and official instructions promulgated by Medicare and other payers.  This document is not an official source nor is it a complete guide on reimbursement.  The reader is reminded that this information, including references and hyperlinks, changes over time, and may be incorrect at any time following publication. 

 

© 2016 Corcoran Consulting Group.   All rights reserved.  No part of this publication may be reproduced or distributed in any form or by any means, or stored in a retrieval system, without the written permission of the publisher. 

 

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