Medicare Reimbursement for Surgical Correction of Corneal Astigmatism

Regular astigmatism occurs when the principle meridians are orthogonal or 90º apart from each other.  Glasses often can correct this type of astigmatism although, if anisometropia exists, surgical correction of the astigmatism may be indicated.  Irregular astigmatism occurs when the two principle meridians are not separated by 90º, and correction cannot be accomplished with glasses; only hard contact lenses or surgical intervention are effective.  Irregular astigmatism is seen in patients with keratoconus, some corneal degenerations such as pellucid marginal degeneration, and corneal scarring, but rarely found in otherwise healthy eyes.

If an eye develops astigmatism (regular or irregular) as a complication of prior ocular surgery and the vision cannot be corrected by conventional means such as eyeglasses or contact lenses, refractive surgery may be indicated.  The Medicare claim for SCOCA includes astigmatism as the primary diagnosis code as well as a supplemental diagnosis further describing the reason for the medically necessary procedure.  It may be helpful to submit additional information that supports the claim such as the operative report, pre- and post-operative refraction, corneal topography, and a description of other failed treatments such as glasses or contact lenses.

The options available to manage refractive errors include spectacles, hard contact lenses, soft contact lenses, and a variety of surgical procedures.  For the patient with an operable cataract and astigmatism, combining a cataract extraction with intraocular lens implant and surgical correction of corneal astigmatism (SCOCA) can reduce or eliminate reliance on postoperative corrective lenses.  This may be an attractive option for many patients, but there are several clinical and reimbursement considerations to be addressed before scheduling surgery.


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