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Although the COVID-19 pandemic postponed surgeries and limited in-person care, patients still need cataract surgery. It’s incumbent on us to handle the pre- and post-op care, whether in-person or through telehealth. Additionally, patient education is more important than ever with new intraocular lens (IOL) technology and refractive surgery procedures.
Now is a good time to review your comanagement protocols to ensure patients are receiving the best care—and you are billing properly for your professional services.
The More You Know
As first-line care providers, we are handling the vast majority of eye care. Thus, we are also the ones on the front lines providing professional advice on IOL choices and making appropriate referrals.
It is our responsibility to be familiar with the various technologies, even new ones such as the PanOptix IOL (Alcon), and the local surgeons who work with each platform, whether it be for a traditional monofocal IOL or a multifocal, toric or multifocal toric lens.
Not only that, but it is critical that your preoperative care include a comprehensive evaluation for the presence of ocular surface disease to ensure best outcomes post-surgically.
The Hand-off
The formal transfer of care begins with the referral to the surgeon. Once this happens, your patient is now formally their patient. Keep in mind that comanagement is a non-financial arrangement between a physician performing surgery and a comanaging physician providing care to the patient for some portion of the global follow-up period.
Back in Your Chair
The comanagement portion of any surgery begins with the formal transfer from the surgeon to the comanaging physician—typically to the physician who originally referred the patient, but not always. Remember, a referral to the surgeon cannot be based on the requirement that the surgeon refer the patient back. Most often, the patient is the one choosing the comanaging physician, so be sure to discuss the arrangement with your patient before the initial surgical evaluation. The patient must request that they be referred back to you for postoperative care.
When billing for the comanagement portion of the patient’s care, the time period is 90 calendar days after the procedure. The appropriate coding for your post-op services is described by the surgical code that the surgeon uses, with the appropriate modifier appended to the code.
Traditional monofocal IOL:
- 6698X – 55 -RT/LT, first eye
- 6698X – 79-55-RT/LT, second eye if performed in the global period of the first eye.
Use the appropriate ICD-10 cataract diagnosis throughout the comanagement period and make sure it matches the surgeon’s code.
Premium IOLs: When billing for a multifocal, use the following code descriptor to bill the patient directly for the premium portion of the IOL (this code is appropriate for the PanOptix and any multifocal toric).
- V2788 – Presbyopia-correcting function of intraocular lens
Make sure that you use the ICD-10 code for presbyopia (H52.4) that is mapped to this code.
When billing for a toric IOL, use the following code descriptor to bill the patient directly for the premium portion of the IOL:
- V2787 – Astigmatism-correcting function of intraocular lens.
Make sure that you use the appropriate ICD-10 code for astigmatism (H52.2XX) mapped to this code.
While it is common for clinicians to set their own fee for the premium portion of IOL comanagement, no money should be paid directly from the surgeon to the comanaging physician. Instead, it is far more prudent to have the patient pay each of the three entities separately for their respective portion of the care provided: one payment each to the surgical center, surgeon and comanaging physician.
COVID-19 should not stymie your comanagement of surgical patients, and making an informed referral to the right surgeon for the best outcome should always be paramount, no matter the circumstances. You must diagnose and treat preoperative conditions before surgical referral and stay up-to-date on new technology to provide the very best outcomes for patients.
Send your coding questions to [email protected].
