Practice Management Considerations for Blended Vision (Lenstec)
FREQUENTLY ASKED QUESTIONS:
PRACTICE MANAGEMENT CONSIDERATIONS FOR BLENDED VISION
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Q What is blended vision?
A Blended vision, also known as pseudophakic monovision, aims to provide excellent unaided vision following cataract surgery for presbyopic patients, using conventional monofocal IOLs, and targeting one eye for distance and the other for near. The surgeon aims for emmetropia in the dominant eye and myopia in the nondominant eye. The degree of spectacle independence depends on the patient’s tolerance for myopic defocus and interocular defocus.
Q Is blended vision suitable for everyone?
A No, blended vision is not appropriate for everyone; monovision is a compromise. Vision is not perfect either up close or far away, stereopsis is diminished, and spectacles may still be required for some tasks. Carefully selected and motivated patients achieve high levels of satisfaction.
Q How does the surgeon evaluate patient suitability?
A The surgeon administers a questionnaire designed to assess the patient’s vision requirements in the normal activities of daily living, and the extent of the patient’s desire for spectacle independence. Next, the surgeon performs a battery of preoperative tests to measure ametropias, ocular dominance, stereopsis, and interocular defocus threshold. All of the tests are refractive in nature and the unit of measurement is diopters. Suitability for blended vision depends on matching patient expectations to tolerance for imbalance between the two eyes.
Q Does Medicare cover pre-operative testing for blended vision?
A No. Refractions, as well as related and screening tests performed solely for the purpose of determining suitability for blended vision, are not covered by Medicare and most other third party payers. (Medicare Claims Processing Manual, Chapter 21, §50.26.1)
Q Should the beneficiary sign a financial waiver for preoperative testing?
A Yes. In the interest of full disclosure, the beneficiary should be advised, in advance of testing, of his or her financial responsibility. A financial waiver can take several forms. An Advance Beneficiary Notice of Noncoverage (ABN) is required for services where coverage is ambiguous or doubtful, and is useful where a service is never covered. For non-Medicare beneficiaries, a Notice of Exclusion from Health Plan Benefits (NEHB) is an alternative to an ABN.
Q How should preoperative testing be coded on claims?
A Refraction is reported as CPT code 92015. Modifier GY is used to indicate that the service is not a Medicare benefit. Since refraction is accompanied by a battery of related tests for blended vision, a single charge should be made for “refraction plus” and modifier 22 (unusual procedural services) appended to the CPT code as well. Modifier 22 indicates an atypical service and also permits an atypical charge. Set your charges based on the services delivered, which can vary by patient and by practice.
Q Is preoperative testing for blended vision bundled with any other services?
A No. Bundles apply only to covered services. Refractions and refractive tests are non-covered and not bundled with any other services.
Q How often may these tests be performed?
A All of these tests are administered prior to the first cataract procedure, and a few of them may need to be repeated prior to the second procedure.
Q What is the reimbursement for refraction?
A Medicare does not pay for refractions. However, as a point of reference, the 2015 national Medicare Physician Fee Schedule assigns RVUs to CPT code 92015 that correspond to about $20.
Nationally, we find a range for regular refractions between $35 and $90. As noncovered services, refractive tests may be priced at market value, which is determined between the physician and the patient. Here, we are contemplating “refraction plus” and the charge should reflect the work involved.
Q Are there other charges associated with blended vision?
A Sometimes. To achieve excellent unaided vision with blended vision, astigmatism must be minimized and higher-order aberrations might also need to be addressed. Additionally, due to the importance of each eye having normal or near-normal potential acuity, other screening tests may be indicated. The surgical correction of preexisting astigmatism is another noncovered service which should be considered for patients with more than 0.50D of cylinder.
For more information on surgical correction of astigmatism, request our monograph, Medicare Reimbursement for Surgical Correction of Corneal Astigmatism. For information about aberrometry and screening tests, request our monograph, Medicare Reimbursement for Ophthalmic Diagnostic Tests.
For a comprehensive discussion of blended vision, please visit our website and access our monograph on this topic, sponsored by Lenstec, Inc.
Provided Courtesy of Lenstec, Inc. (866) 536-7832
Last updated February 16, 2015
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.
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