Preop Requirements for Cataract Surgery

American Academy of Ophthalmology Web Site: www.aao.org
Original URL:

Savvy Coder: Coding & Reimbursement

By Sue Vicchrilli, COT, Academy Coding Executive,
and Michael X. Repka, MD, OCS, Academy Secretary for Federal Affairs

During last year’s Annual Meeting in Chicago, an attendee at one of the AAOE sessions inquired if preop guidelines for cataract surgery had been standardized across all the states. Much to her dismay, the answer is no.

Requirements by State

The following is a brief overview of what different states require for visual acuity with, of course, modifying factors.*

Alabama—policy with no specific vision requirement
Alaska—retired policy
Arizona—retired policy
Arkansas—no policy
California—retired policy
Colorado—retired policy
Connecticut—no policy
Delaware—20/40
District of Columbia—20/40
Florida—no policy
Georgia—20/50
Hawaii—retired policy
Idaho—20/50
Illinois—no policy
Indiana—20/50
Iowa—retired policy
Kansas—no policy
Kentucky—20/50
Louisiana—no policy
Maine—retired policy
Maryland—20/40
Massachusetts—retired policy
Michigan—no policy
Minnesota—no policy
Mississippi—policy with no specific vision requirement
Missouri—no policy
Montana—20/50
Nebraska—no policy
Nevada—retired policy
New Hampshire—retired policy
New Jersey—retired policy
New Mexico—no policy
New York—retired policy
North Carolina—20/50
North Dakota—retired policy
Ohio—20/50
Oklahoma—no policy
Oregon—retired policy
Pennsylvania—20/40
Rhode Island—no policy
South Carolina—20/50
South Dakota—retired policy
Tennessee—20/50
Texas—20/40
Utah—no policy
Vermont—retired policy
Virginia—20/40
Washington—retired policy
West Virginia—20/50
Wisconsin—no policy
Wyoming—retired policy

Retired policies still apply to services provided before the retirement date, which carriers list online. If applicable, there also will be a link to any superceding policy or coverage decision.

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* To read the entire policy from your payer’s Web site, go to www.aao.org/aaoesite/coding and select "Coding Tools" for its URL.

HCPCS Code V2788 for Presbyopia-Correcting IOLs

The Centers for Medicare and Medicaid Services (CMS) announced a new HCPCS code for reporting noncovered charges associated with the insertion of presbyopia-correcting IOLs.

Providers, hospitals and ASCs may report this code to reflect the additional charges.

This new HCPCS code is V2788, which is defined as Presbyopia-correction function of an intraocular lens. It became effective Jan. 1, 2006.

The program memorandum also clarifies that CPT codes 66985—defined as Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract extraction—and 66986—defined as Exchange of intraocular lens—may be used to report the insertion or replacement of one of these presbyopia-correcting lenses as well as conventional lenses.