JUN 07, 2022
Noridian Reports Cataract Documentation Failure Rates
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.
- 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
- The most common documentation deficiencies included best corrected visual acuity, cataract grade and functional impairment.
- 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 SolutionsEngage 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/lcdsFact Sheet for Documenting the Need for Cataract Surgery - American Academy of Ophthalmology
Video: Cataract Documentation Checklist - American Academy of OphthalmologyCataract Controversies — Answers to Contentious Coding Questions — American Academy of Ophthalmology