Practice Management Considerations for Blended Vision (Lenstec)

Since a large percentage of cataract patients also have presbyopia and astigmatism, eliminating ametropias is the new goal, not just improving vision by removing lens opacities.  To do so entails combining cataract and refractive surgery to provide an improved outcome for discriminating patients who wish to be less dependent on spectacles.  With the introduction of presbyopia-correcting and astigmatism-correcting intraocular lenses (IOLs), surgeons have more ways to perform refractive cataract surgery.

From a practice management perspective, enthusiasm for this concept grew from the ability to collect reimbursement from Medicare and other third party payers for covered cataract surgery, and simultaneously charge the patient for non-covered refractive services such as limbal relaxing incisions (LRI) to correct astigmatism.  While CMS’ Ruling Number 05-01 concerning presbyopia-correcting IOLs formalized this idea within a regulatory context, it did not depend on new legislation to take effect – it only applied existing statutes.  Although not always appreciated, the concepts which underlie Rule 05-01 preceded it and have applicability to cases not solely involving presbyopia- or astigmatism-correcting IOLs.

Some members of the ophthalmic community have expressed concern about the legal and ethical basis for charging cataract patients anything other than the copayment and deductible for covered services.  This potential obstacle is readily removed by paying close attention to the clear boundaries between noncovered and covered services.

This monograph examines how blended vision, or pseudophakic monovision, fits within longstanding coverage and payment rules for cataract surgery.  It identifies applicable CPT and ICD-9 codes that pertain to the professional and facility services related to refractive cataract surgery.  Relevant modifiers are noted as well.  The Appendix contains useful financial waiver forms.

 

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Provided Courtesy of Lenstec, Inc.

 

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