• Preop Requirements for Cataract Surgery

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

    This article is from May 2006 and may contain outdated material.

    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
    District of Columbia—20/40
    Florida—no policy
    Hawaii—retired policy
    Illinois—no policy
    Iowa—retired policy
    Kansas—no policy
    Louisiana—no policy
    Maine—retired policy
    Massachusetts—retired policy
    Michigan—no policy
    Minnesota—no policy
    Mississippi—policy with no specific vision requirement
    Missouri—no policy
    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
    Oklahoma—no policy
    Oregon—retired policy
    Rhode Island—no policy
    South Carolina—20/50  
    South Dakota—retired policy
    Utah—no policy
    Vermont—retired policy
    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.

    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.