Coding: Cataract Documentation
Date: April 1, 2024
As the most frequently performed ophthalmic surgeries, cataract procedures continue to receive payer scrutiny. Between the Targeted Probe and Educate audits, the 2022 Supplemental Medicare Review Contractor (SMRC) audit conducted by Noridian, the 2022 Medicare Fee-for-Service Supplemental Improper payment data, and attention from non-Medicare payers, many cataract surgeons are reviewing their charts and claims and, where necessary, making changes to strengthen the notes.
During the patient’s cataract exam or consultation, the surgeon determines the medical necessity for cataract surgery based on the exam findings and the patient’s desire for surgery. Insurance payers, including Medicare, provide their own requirements for medical necessity to support reimbursement of claims for cataract surgery.
Before scheduling surgery, providers are encouraged to confirm that both the clinical need for surgery and the payer’s requirements for payment are met and documented.
Practice staff also play an important role in preparing appropriate medical records and correct claims. Here is a summary of how to establish and document the need for cataract surgery.
Published in: Ophthalmic Professional’s Coding column
Written by: Corcoran’s Senior Consultant, Mary Pat Johnson, COMT, CPC, COE, CPMA
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