How to Bill for New Technology IOLs

How should our freestanding ASC code and bill for the new technology intraocular lenses (NTIOLs) that are eligible for a $50 payment adjustment from Medicare?

Starting May 18, 2000, you can get an extra $50 when using the following two lenses:
- The Allergan AMO Array Multifocal Model SA40N. Use HCPCS code Q1001.
- The STAAR Surgical Elastic Ultraviolet-Absorbing Silicone Posterior Chamber IOLs, models AA4203T, AA4203TF and AA4203TL. Use HCPCS code Q1002.

The Staar Toric, above, and the Allergan Array, below, both qualify for an additional $50 reimbursement.

To receive the extra payment, report the HCPCS code with one of the following CPT codes for cataract extraction surgery:

66983. Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one stage procedure) - ASC Payment Group 8.

66984. Extracapsular cataract removal with insertion of IOL (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phaco) - ASC Payment Group 8.

66985. Insertion of IOL (secondary implant), not associated with concurrent cataract removal - ASC Payment Group 6.

66986. Exchange of intraocular lens - ASC Payment Group 6.

Medicare will pay a flat $50 premium over and above the $150 payment allowance already included in the ASC facility fee for a standard IOL.

Fill out the HCFA-1500 claim form as follows:
In Box 24B (Place of Service) report "24" for ambulatory surgery center.
In Box 24C (Type of Service) report "F" for ambulatory surgery center facility service.

Bill using two line items in box 24D. One line item must show a cataract extraction CPT code - 66983, 66984, 66985, or 66986 - whichever appropriately describes the procedure performed. A second line item must show the correct Q code for the Medicare approved NTIOL. Medicare will then reimburse you the extra $50, subject to coinsurance and deductible.

The modifier "SG," which ensures that claims for ASC facility services are paid under the ASC Payment Groups 1-8, must also appear in box 24D on the HCFA-1500 form.

Note that if you submit a HCFA-1500 claim to your Medicare carrier containing only a Q code for the NTIOL, the carrier will regard the claim as incomplete and will return it to you as unprocessable.

1. Federal Register, p. 25740, May 3,2000.
2. Federal Register, June 16,1999.
3. Program Memorandum Carriers, Transmittal No. B-99-19, April 1999,
Department of Health and Human Services, Health Care Financing Administration.

Lolita M. Jones, RHIA, CCS, is a Registered Health Information Administrator and a Certified Coding Specialist. She has more than ten years experience in publishing, training, and consulting for freestanding ASCs. If you have a coding question for Ms. Jones that you would like her to answer in this column, please e-mail it to [email protected].

Ms. Jones can also be reached directly at 301-292-8027 or at [email protected].