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postop cataract surgery eyeglasses billing to Medicare: DME

Carole Posted Wed 06th of May, 2015 01:13:40 AM

How do I bill postop cataract surgery eyeglasses to Medicare DME?
I thought we were billing correctly, but all of my claims are being rejected. One consultant advised me that I need a separate NPI number for billing eyeglasses postop cataract surgery; my billing service told me that is not true. Help!

SuperCoder Answered Wed 06th of May, 2015 04:09:39 AM

Post-operative coding for durable medical equipment is always challenging and doubtful as well. Well, medicare does not pay for eyeglasses, contact lenses or low-vision devices except for diagnoses related to cataracts (one pair per lifetime per eye after cataract surgery with implant) or surgical or congenital aphakia (frequency based on a doctor's recommendation). If the diagnosis is not related to cataract extraction with implant or aphakia, there is no point in billing the supply of eyeglasses, contacts or low vision devices to Medicare. When billing Medicare for post-op eyeglasses, possible payable diagnosis codes include are pseudophakia, aphakia, congenital aphakia. And it can bill under same NPI number.

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