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Editor's Note: This article by Paul Cadorette, director of education for mdStrategies, originally appeared in The Coding Advocate, mdStrategies free monthly newsletter. Sign-up to receive this newsletter by clicking here.
We are accustomed to seeing IOLs implanted during cataract surgery and on some occasions a clear lens exchange with IOL insertion for conditions such as myopia. There is now a new technology that the ASC coder should become familiar with, and that is the telescopic IOL or LMI (Lipschitz macular implant) for the treatment of age-related macular degeneration (AMD).
Within the macula of the eye is small depression called the fovea which is responsible for central field vision and has a high density of photoreceptors that allow for the sharpest and clearest picture of images that the eye is focused on. However, there are certain types of diseases that can have an adverse effect on the macula causing degeneration of the tissue in this area with loss of central vision and image clarity.
The telescopic or LMI lens is different from conventional IOL models in that it has two mirrors that are used to enhance and magnify images. Although many of the photoreceptors in the macular area can be damaged due to diseases, the peripheral photoreceptors remain intact. The purpose of a telescopic IOL is to magnify an image so that a much larger picture is projected onto the retina, allowing the peripheral photoreceptors to pick it up so that the image can be seen by the patient. For example: x --->X (normal image on the left passes through the lens and magnified two to three times its size).
CMS has published the following information with regards to coding and reimbursement;
January 2012 Update of the Ambulatory Surgery Center (ASC) Payment System
CMS has determined that it is able to identify a portion of the OPPS payment associated with the cost of HCPCS code C1840 for the insertion procedure described by new HCPCS code C9732 (Insertion of ocular telescope prosthesis including removal of crystalline lens). Therefore, ASC payment for the nondevice facility resources for the insertion procedure will be based upon the nondevice portion of the related OPPS payment weight for HCPCS code C9732. The ASC Code Pair File will be used to establish the reduced ASC payment amount for HCPCS code C9732 only when billed with HCPCS code C1840.
Billing Instructions for C9732 and C1840
Pass-through category C1840 (Lens, intraocular (telescopic)), is to be billed and paid for as a pass-through device only when provided with C9732 (Insertion of ocular telescope prosthesis including removal of crystalline lens) beginning on and after the effective date for C9732 of January 1, 2012.
Whenever you're talking about a new procedure, it's always a good practice to check with your local carriers to confirm that these are the guidelines that will be used in processing your claims.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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