Target probe and educate (TPE) audits performed by Novitas in the first quarter of 2024 continue to highlight poor documentation of cataract extraction exams and operative notes.

The reasons for denial include:

• Documentation submitted did not support medical necessity.
  • Did not meet LCD requirements
  • Missing affected activities of daily living (ADL)
  • No evidence of eye exam prior to surgery
• Documentation submitted was insufficient and not resolved upon additional request.
  • No response to documentation requests
• Incorrect eyes were cited in exam and/or operative notes.
• Wrong dates of service were billed.

The lack of documentation rendered the determination that services were billed to Medicare in error. Additional rounds of review will continue with newly identified surgeons.

The Academy provides comprehensive education on cataract surgery documentation. Audit-proof your cataract surgery procedures with these trusted resources.