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AcrySof IQ Toric Models SN AT SN AT SN AT collectively astigmatism

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AcrySof IQ Toric Models SN AT SN AT SN AT collectively  astigmatism Powered By Docstoc
					  AcrySof® IQ Toric (Models SN6AT3, SN6AT4, SN6AT5, collectively referred to as SN6ATT)
  Two-aspect Frequently Asked Questions
        What are the special reimbursement categories for AcrySof® IQ Toric intraocular lenses?
        The AcrySof® IQ Toric IOL is included in Medicare Ruling CMS-1536-R which addresses two-aspect billing for astigmatism-
        correcting IOLs. For dates of service on or after July 31, 2009, the AcrySof® IQ Toric is also included in CMS’s New
        Technology Intraocular Lens (NTIOL) category which allows ASCs an additional $50 for Medicare patients. Billers in the
        ASC setting should also refer to NTIOL Frequently Asked Questions for AcrySof® IQ Toric for more detailed information.

               Models                  Description                          CMS Payment Category                       HCPCS Code
             SN6AT3                    AcrySof® IQ Toric IOL                Ruling CMS-1536-R                          V2787 – Astigmatism-correcting function
             SN6AT4                                                                                                    of an intraocular lens
             SN6AT5                                                         AND                                        (Applies to non-covered component)
                                                                            NTIOL (New Technology                      Q1003 – New technology intraocular lens,
                                                                            Intraocular Lens)                          category 3, reduced spherical aberration,
                                                                                                                       (Applies to covered component)

        How will physicians and facilities be reimbursed when patients choose AcrySof® IQ Toric IOL?
        CMS pays the bundled fee for those items and services related to the cataract procedure that are customarily covered and
        paid for by the program. The facility may bill the patient for charges associated with the non-covered aspect of the
        lens (i.e., an astigmatism-correcting aspect), and surgeons may charge the patient for any medically appropriate, non-
        covered services related to correction of pre-existing astigmatism. No items or services that are associated with treating
        the cataract may be charged to the patient. This approach is known as the two-aspect payment model.

        What is the two-aspect payment model?
        Both Ruling 05-01 and Ruling CMS-1536-R indicate that a single device can have two clinical functions: 1) one which provides
        a covered benefit, and 2) one which provides a non-covered benefit. The following is an overview of the application of the
        two-aspect payment model:

                                                   COVERED                                                   NON-COVERED
                                                   Cataract surgery CPT® codes 66984,                        Facility charge for surgery w/toric IOL minus
                      FACILITY                     66982 (ASCs also bill Q1003)                              facility charge for surgery with conventional
                                                   Fee Schedule                                              IOL equals patient payment
                                                   Cataract Surgery CPT Codes 66984,
                                                                                                             Customary charges for non-covered services
                      PHYSICIAN                    66982
                                                                                                             equals patient payment
                                                   Fee Schedule
                   66984- Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation
                   and aspiration or phacoemulsification)
                   66982- Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation
                   and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (e.g., iris expansion device,
                   suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage
                   Fee schedule- A complete listing of fees used by health plans to pay doctors or other providers.

        When did AcrySof® IQ Toric IOL become eligible for the two-aspect payment model?
        CMS released Ruling No. CMS-1536-R on January 22, 2007, and the AcrySof® IQ Toric models were included in the ruling in
        May 2009.

        What services may physicians bill to the patient for the AcrySof® IQ Toric IOL?
        The surgeon may only seek payment from Medicare beneficiaries for those tests and services that are performed solely
        for treating astigmatism and that would not otherwise be performed in connection with a cataract procedure with the
        implantation of a conventional IOL. For example, corneal topography generally is not performed in connection with the
        implantation of a conventional IOL nor is it bundled in the physician payment for performing cataract surgery.

        1. Physician must determine whether a particular diagnostic test is covered under its carrier’s coverage policies.


                                                                                        REIMB001-A-2009


0908S13 IQ_Toric 2 Aspest FAQ.indd 1                                                                                                                                          8/21/09 11:19:26 AM
                                                                                                                                                                   0908S13 IQ_Toric 2 aspect
        What codes should be used when using AcrySof® IQ Toric IOL in a cataract surgery?
        The cataract surgery itself should be billed by the physician and the facility with the usual CPT procedure codes (66984 or
        66982), and the appropriate diagnosis code from category 366.XX (cataract), and 367.2X (astigmatism). Additional coding
        applies to ASCs when the AcrySof® IQ Toric is implanted in a Medicare beneficiary (see the NTIOL FAQs for AcrySof® IQ
        Toric).

        Are there any specific codes associated with the astigmatism-correction two-aspect model?
        HCPCS code V2787 (astigmatism correcting function of an intraocular lens) should be used to track and account for non-
        covered services associated with the insertion of CMS approved astigmatism-correcting lenses. Code V2787 may be used
        by providers, hospitals and ASCs to reflect non-covered charges for the AcrySof® IQ Toric IOL.
        CMS does not require non-covered services to be listed on the claim unless it is at the request of the patient.
        In that case, the HCPCS code V2787 along with modifier GY or GA may be used by the facility or physician.

        Should physicians and facilities use HCPCS code V2788 to report non-covered services?
        No, V2788 is defined as “Presbyopia correcting function of an intraocular lens”.

        Does CMS require providers to obtain an ABN (Advanced Beneficiary Notice) from the patient?
        CMS does not require an ABN, but “strongly encourages” that an NEMB (Notice of Exclusion from Medicare Benefits)
        be used2. (Note: In 2008, CMS updated the ABN to also serve as an NEMB.) A sample ABN with language specific to
        AcrySof® IQ Toric is available on the Alcon Reimbursement Services webpage.

        Are any private insurance carriers permitting a higher reimbursement for a toric lens or allowing a surgeon/
        facility to charge for additional services when using an AcrySof® IQ Toric IOL?
        The provider should contact the individual payer and request clarification.

        Whom can I contact for additional information?

                    Alcon Reimbursement services is available
                    to assist you with additional questions.
                    Email us at ars@alconlabs.com, or call us
                    toll-free at (866) 457-0277
                                                                                                              Toll free (866) 457-0277 ARS@alconlabs.com




        Additional information on Ruling No. CMS-1536-R can be obtained directly from the CMS website at
        http://www.cms.hhs.gov/Rulings/downloads/CMS1536R.pdf
        http://www.cms.hhs.gov/transmittals/downloads/R1228CP.pdf
        www.cms.hhs.gov/MLNMattersArticles/downloads/MM5527.pdf
        http://www.cms.hhs.gov/ASCPayment/08_NTIOLs.asp

        CPT and all CPT codes are copyrighted by the American Medical Association with all the rights and privileges pertaining.




  This FAQ is meant only as a reference, and should not be considered specific billing and coding advice, and does not cover individual policy variations across   REIMB041-2009
  local Medicare Carriers or specific commercial payers. Users of this guide are encouraged to contact their carriers directly for specific information.



0908S13 IQ_Toric 2 Aspest FAQ.indd 2                                                                                                                               8/21/09 11:19:26 AM

				
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Description: AcrySof IQ Toric Models SN AT SN AT SN AT collectively astigmatism