Cataract surgery continues to be one of the most common surgeries performed, and because of this, remains a top audit target for all payers. 

Noridian Health Care Solutions, the Medicare administrative contractor (MAC) responsible for several midwestern and western states, shared its post-payment cataract data in a recent webinar. Noridian’s audit data included these three findings.

1. Required documentation was missing from the MACs’ local coverage determination (LCD) policies and local coverage articles (LCA), including: 
   • 71.3% claims submitted from Alaska, Idaho, Oregon, and Washington
   • 26.6% claims submitted from Arizona, Utah, Montana, North Dakota, South Dakota and Wyoming
2. The most common documentation deficiencies  included best corrected visual acuity, cataract grade and functional impairment. 
3. The top deficiencies in 2022 were these missing patient statements: 
   • Indication that vision could not be improved by other means 
     • Such as glasses or contact lenses
   • Indication that removal of cataract is expected to improve vision

Academy tools and resources are available to help you prepare for your next cataract audit. Noridian and other MACs also offer published resources. 

Academy Solutions

Engage Academy consultation services for chart audits and cataract documentation reviews.
 
Accurately code tests and segment surgical procedures using the 2022 Coding Assistant: Cataract and Anterior Segment
 
Ultimate Documentation Compliance Training for Scribes and Technicians is the comprehensive online course that transforms practice staff into a “compliance shield.”

Academy Resources

Find current cataract requirements for your Medicare administrative contractors at www.aao.org/lcds

Fact Sheet for Documenting the Need for Cataract Surgery - American Academy of Ophthalmology

Video: Cataract Documentation Checklist - American Academy of Ophthalmology

Cataract Controversies — Answers to Contentious Coding Questions — American Academy of Ophthalmology

Noridian Resources

• Cataract Surgery Policy Checklist
• Cataract Issues Webinar: Cataracts