• Filling Out Claim Form When Comanaging


    Question: Our surgeon is performing cataract surgery on a Medicare Part B patient that will be comanaged. We are monitoring the patient for the first seven days. How do we correctly submit the claim?

    Answer: The example below shows how the claim form should be submitted:

    Patient desires to return to their non-surgical ophthalmologist Dr. Smith for postoperative care following cataract surgery in the right eye, as Dr. Smith’s practice is closer to the patient’s home. Dr. Jones, the surgeon, performs cataract surgery on March 2, 2018 and submits 66984 -54 -RT. Dr. Smith provides postoperative care for all but the first postop date beginning March 9.

    Dr. Jones (surgeon) submits as follows:

    CMS-1500 Claim Form or Electronic Equivalent

    Item 24a 03/02/18
    Item 24d 66984 -54  -RT
    Item 24f Surgical charge
    Item 24g 1

    Dr. Smith (providing postop) submits as follows:

    CMS-1500 Claim Form or Electronic Equivalent

    Item 19 03/02/18 - 5/30/18
    Item 24a 03/02/18
    Item 24d 66984 -55 -RT
    Item 24f Postoperative charge
    Item 24g 90

    Should Dr. Jones (surgeon) provide 7 days of postoperative care, claim submission would reflect:

    CMS-1500 Claim Form or Electronic Equivalent

    Item 24a 03/02/18
    Item 24d 66984 -54 -RT
    Item 24f Surgical charge
    Item 24g 1

    And for the 7 postoperative days:

    CMS-1500 Claim Form or Electronic Equivalent

    Item 19 03/02/18 - 03/09/18
    Item 24a 03/02/18
    Item 24d 66984 -55 -RT
    Item 24f Pro-rated fee
    Item 24g 7