Question: A patient had cataract surgery three years ago and now needs surgery to correct astigmatism induced by the surgery. Some carriers seem to limit the timeframe for when we can perform the surgery. Can we bill the payer for the procedure or should it be the patient’s responsibility?

Answer: Most insurances don't specify (at least in writing) the amount of time passed or the specific diopter of astigmatism induced by surgery or trauma for CPT code 65772 Corneal relaxing incision for correction of surgically induced astigmatism. For Medicare Part B, obtain an Advance Beneficiary Notice and append modifier –GA, indicating that you have the ABN on file in the office. Other payers may require a prior authorization or have their own form similar to the ABN. This way, if insurance doesn't cover the procedure, you have informed the patient that s/he is responsible for payment.