LCD/NCD Portal

NCD10.1

 

USE OF VISUAL TESTS PRIOR TO AND GENERAL ANESTHESIA DURING CATARACT SURGERY

 

Effective Date of this Version

8/31/1992 Description Information

 

Indications and Limitations of Coverage

• Pre-Surgery Evaluations

o Cataract surgery with an intraocular lens (IOL) implant is a high volume Medicare procedure.

 Along with the surgery, a substantial number of preoperative tests are available to the surgeon.

 In most cases, a comprehensive eye examination (ocular history and ocular examination) and a single scan to determine the appropriate pseudophakic power of the IOL are sufficient.

 In most cases involving a simple cataract, a diagnostic ultrasound A-scan is used.

 For patients with a dense cataract, an ultrasound B-scan may be used.

o Accordingly, where the only diagnosis is cataract(s), Medicare does not routinely cover testing other than:

 One comprehensive eye examination (or a combination of a brief/intermediate examination not to exceed the charge of a comprehensive examination).

And

 An A-scan.

Or

 If medically justified, a B-scan.

 Claims for additional tests are denied as not reasonable and necessary unless there is an additional diagnosis and the medical need for the additional tests is fully documented.

o Because cataract surgery is an elective procedure, the patient may decide not to have the surgery until later, or to have the surgery performed by a physician other than the diagnosing physician.

 In these situations, it may be medically appropriate for the operating physician to conduct another examination.

 To the extent the additional tests are considered reasonable and necessary by the carrier's medical staff, they are covered.

• General Anesthesia

o The use of general anesthesia in cataract surgery may be considered reasonable and necessary if, for particular medical indications, it is the accepted procedure among ophthalmologists in the local community to use general anesthesia.

 

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