Understanding Cataract Co-Management Billing

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Understanding Cataract Co-Management Billing
Billing and coding for cataract co-management can
be tricky. Its important that all parties
involved should get accurately reimbursed for
their time and expertise. To explain cataract
co-management billing, we discussed everything
starting from defining co-management the
relationship between involved parties required
forms to be filled CPT codes and modifiers and
key boxes in the CMS-1500 form. Lets begin with
an understanding of what is co-management in
cataract surgeries. Defining Co-Management The
American Academy of Ophthalmology defines
co-management as, a relationship between an
operating ophthalmologist and a non-operating
practitioner for shared responsibility in the
post-operative care period when the patient
consents in writing to multiple providers, the
services being performed are within the
providers respective scope of practice and there
is written agreement between the providers to
share patient care. As per cataract
co-management billing guidelines, its important
to define the relationship between an operating
ophthalmologist and a non-operating practitioner
for shared responsibilities in the post-operative
care period.
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Understanding Cataract Co-Management Billing
The first question that has to be
answered is who is seeing the patient for what
appointments. You, as the optometrist, are doing
the initial consult, but after the surgery, where
will the patient go for their postoperative
care? This can vary based on your OMD group as
well as your comfort level as a practitioner.
When co-managing cataract surgery, do you want to
see the cataract patient at their 1-day post-op
visit? The 1 week? The 1 month? Some surgeons
prefer to see their patients at the 1-day
visit. This co-management system should also
include automated scheduling of all necessary
post-op visits on the same day as the patients
surgical consultation. The ophthalmology surgical
coordinator should have direct contact with your
office and call to schedule all appropriate
follow-up visits when necessary.
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Understanding Cataract Co-Management Billing
This takes away any responsibility from the
patient and ensures the patient will be seen for
their necessary post-operative care. In addition
to this appointment schedule, there has to be a
specific paper trail between you and the
ophthalmologist. These forms include an initial
referral form from OD to OMD a patient election
for co-management form a transfer of care form
and a post-operative assessment sheet. Both the
patient election for co-management and transfer
of care form is required if you are going to be
reimbursed for co-management services. These
forms must be signed by the patient and kept
within the patients medical records. Cataract
Co-Management Billing How do optometrists get
paid for their time and co-management? The
essence of cataract co-management billing lies
with the procedure (CPT) codes, applicable
modifiers, and transfer of post-op care
date. Most patients that undergo cataract
surgery will be using Medicare, we will refer to
procedure codes and modifiers which are
applicable while billing Medicare.
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Understanding Cataract Co-Management Billing
You can refer to payer-specific billing
guidelines as modifiers and CPT codes might
change.  Billing scenario On the day of the
surgery, the surgeon will likely bill out CPT
code 66984 with modifier 54. Modifier 54
indicates the surgical event is a co-managed
case. The optometrist will then bill out CPT code
66984 with Modifier 55 on the date that they see
the patient, which indicates post-op management
only. You have to use the modifier RT/LT to
indicate which eye was operated on. Additionally,
most patients will undergo surgery for their
second eye during this global period. Modifier
79 is used to identify that the surgery is
unrelated to the first eye.  Medicare assigns 80
percent of the reimbursement to the
intraoperative service, so 20 percent is left for
our co-management. Within that 20 percent
Medicare splits it between co-managing providers
based on the number of days each provider is
responsible for post-op care during the global
period (90 days post-op). Currently, most
insurance carriers cover only basic IOL implants.
As the co-managing doctor, it is encouraged to
discuss all the options with your patients,
including premium IOLs (astigmatism correction,
multifocal correction) and the addition of laser,
which will have the best visual result.
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Understanding Cataract Co-Management Billing

• The patient is responsible for these costs and
  depending on the relationship with your
  co-management provider, you may be eligible for
  additional compensation for the increased level
  of care required with these options.
• Crucial Boxes in CMS-1500
• Ensure your diagnosis matches the surgeons
  diagnosis.
• Ensure your CPT code matches the surgeons CPT
  code 66984 for regular or 66982 for the complex.
• The date of service is the actual date of the
  surgery.
• Box 33 Must contain the optometrists practice,
  not the surgeons practice.
• Box 17 Insert the surgeons name.
• Box 17B Insert the surgeons NPI.
• Box 19 Type in the following words and actual
  dates ASSUMED 00/00/0000 RELINQUISHED
  00/00/0000 (This is the 90-day global period.
  Date Calculator.)
• Box 24G (days or units) Medicare replacements
  and commercial insurances will only accept 1
  unit and you bill for the total dollar amount of
  the co-management period.
• Initial Treatment Date, the Additional Claim Info
  tab must contain the date of surgery if the claim
  will be submitted electronically.

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Understanding Cataract Co-Management Billing

• 1st eye CPT-66984 or 66982, then modifier LT or
  RT, then modifier 55 for co-management.
• 2nd eye CPT-66984 or 66982 if during the 90-day
  global of the 1st eye then add LT or RT and both
  of the following modifiers 55 for co-management
  and 79 for an unrelated procedure or service by
  the same physician during post-op care.
• If the 90-day global period is over before
  billing the 2nd eye, or you are only billing for
  one eye, then it gets coded like the 1st eye
  example above.
• Note that traditional Medicare will only accept
  90 units (or the actual number of days you
  co-managed the patient). In this situation, you
  would divide the number of days you co-managed
  the patient by your total co-management fee and
  bill that dollar amount as a Per-day amount.
  Your states Medicare carrier may vary. For
  example, you may bill one payer Units 1 Fee
  300. And for Medicare you would bill Units
  90 Fee 3.33
• As mentioned earlier, billing and coding for
  cataract co-management can be tricky due to the
  involved parties.
• Additional Resource
• Tips for Eye Surgery Billing A Guide for
  Optometry Specialists

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Understanding Cataract Co-Management Billing
Medical Billers and Coders (MBC) which is a
leading medical billing company can assist you in
accurately billing for cataract
co-management. Our complete optometry billing
and coding services can help you receive accurate
reimbursement for delivered services. To know
more about our optometry billing and coding
services, call us at 888-357-3226 or email us
at info_at_medicalbillersandcoders.com.