2014 CODING UPDATE

Increases RVU (Medcr) EM office visits (99xxx) +3% Ophthalmic office visits (92xxx) +6% Ext. Ophthal. (92225/6) +5% ($28/$25) Topography (92025) +6% ($38) Foreign Body, Conj. (65205) +6% ($58) Cornea puncture, tattoo (65600) +6% ($411) Probe canaliculi (68840) +7% ($135)

Decreases RVU (Medcr) Fundus Photo (92250) -6% ($81) Cornea FB w/SL (65222) -7% ($70) Fit CL for ocl. surface dx (92071) -10% ($34) Cat. Sx. w/ IOL (66984-55) -12% ($134) Photo, External (92285) -14% ($21) Visual Field, Extnd. (92083) -26% ($67) Photo, Specular Micrscpy (92286) -69% ($39)

Amniotic Membrane 65778 Placement of of amniotic membrane on the ocular surface for wound healing; self-retaining Recurrent corneal erosion, infectious/inflammatory keratitis, herpes, superficial epithelial defects, severe dry eye, cornea disease.

Amniotic Membrane For healing persistent epithelial defects, ulcers. When bandage CL needed, want inflammation control, but cant use steroid. $1469 (Medcr) Cost $800 Paid by Medicare in several states.

Amniotic Membrane Bio-Tissue PROKERA www.biotissue.com

Scanning Laser for Plaquenil V58.69 Long term (current) use of other medications; Other high-risk medications Nine Medicare Part B contractors: 6 approve V58.69 (Novitas, CGS, First Coast, NGS, NHIC, WPS). Three (Cahaba, Noridan, Palmetto) are silent about V58.69 -- they have no LCD for OCT.

Scanning Laser for Plaquenil States with Cahaba, Noridan, Palmetto: if 92134 with V58.69 is denied (as in the past), submit an appeal, giving evidence that Novitas, CGS, First Coast, NGS, NHIC, WPS pay for V58.69. Chances are good the contractor will reverse its decision and it will be paid.

Medicare MEDICARE PAYMENT REDUCTION PROGRAMS: OPPS, MPPR, SEQUESTRATION

Medicare OPPS - Medicare put payment cap on some diagnostic imaging services, based on fee caps of Hospital Outpatient Prospective Payment System (OPPS). The only optometric code affected is 92250 Fundus Photography.

Medicare MPPR - Medicare reduces payment on some diagnostic ophthalmology procedures, when two (or more) are billed on the same day. The MPPR (Multiple Procedure Payment Reduction) reduces payment on the 2nd code (and the 3rd, 4th, etc).

Medicare MPPR – The first diagnostic procedure is paid at the normal rate. The first diagnostic procedure is defined as the one with highest value.

Medicare MPPR – 76514 Pachymetry 92025 Corneal topography 92060 Sensorimotor exam 92083 Visual field, extended 92132 Scanning imaging, anterior segment 92133 Scanning imaging, optic nerve 92134 Scanning imaging, retina

Medicare MPPR – 92250 Photo, fundus 92285 Photo, external 92286 Photo, specular endothelial microscopy file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee 2013 15.4.xlsx

Medicare SEQUESTRATION - Federal budget problems resulted in an overall 2% reduction of physician pay. Medicare pays the physician 78% of the allowed payment, and the patient still owes 20% of the Allowed Payment. Allowed Payment remains the same. file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee 2013 15.4.xlsx

GLAUCOMA STAGE ICD CODES

Using Glaucoma Stage Code Select ICD code for type of glaucoma (same as past) from 38 glaucoma codes (365.xx)

If selected code is one of 11 (below), add Glaucoma Stage code in 2nd position on claim form   365.10 Open-angle glaucoma, unspecified 365.11 Primary open angle glaucoma 365.12 Low tension glaucoma 365.13 Pigmentary glaucoma 365.20 Primary angle-closure glaucoma, unspecified

365.23 Chronic angle-closure glaucoma 365.31 Corticosteroid-induced glaucoma, glaucomatous stage 365.52 Pseudoexfoliation glaucoma 365.62 Glaucoma associated with ocular inflammations 365.63 Glaucoma associated with vascular disorders 365.65 Glaucoma associated with ocular trauma

Select Glaucoma Stage code (physicians judgment)   365.70 Glaucoma stage, unspecified No documentation regarding stage of glaucoma 365.71 Mild stage glaucoma Optic nerve changes consistent with glaucoma No VF loss on white-on-white perimetry VF loss may be on short-wavelength automated perimetry or frequency-doubling perimetry

365.72 Moderate stage glaucoma 365.73 Severe stage glaucoma Optic nerve changes consistent with glaucoma VF loss in one hemifield Not within 5° of fixation   365.73 Severe stage glaucoma Optic nerve change consistent with glaucoma VF loss in both hemifields VF loss within 5° of fixation in at least one hemifield

Glaucoma stage cannot be determined 365.74 Indeterminate stage glaucoma Glaucoma stage cannot be determined Had no time to do VF Patient can’t do VF VF unreliable or uninterpretable, so stage of glaucoma is unsure Do not confuse 365.74 with 365.70 which is no documentation regarding stage of glaucoma

Bilateral Glaucoma Same type and stage Report one code for type of glaucoma, and one Glaucoma stage code   Same type but different stage Report one code for type of glaucoma, and one Glaucoma stage code for the highest glaucoma stage Each eye different type and different stage Report two codes, one for each type glaucoma, and one Glaucoma stage code for highest glaucoma stage

Claim Form Enter stage code adjacent to glaucoma diagnosis Report with office visit code and every related procedure done during visit

Secondary Codes Glaucoma stage codes are secondary add-on codes Glaucoma stage codes are not principal or first-listed or primary diagnosis codes

HIPAA Adherence to ICD guidelines is required by HIPAA HIPAA applies to anything transmitted electronically Some plans may be slow to recognize new codes

PAYMENT IF NOT REPORTED? Florida MAC says Yes Noridian? WPS? Non-Medicare?

INFORMATION Teaching tool by AGS Google “American Glaucoma Society” http://www.americanglaucomasociety.net/professionals/glaucoma_staging_codes_teaching_module/ Google “American Glaucoma Society”

CPT CODES Deleted 2012 92070 Fitting of contact lens for treatment of disease, including supply of lens

CPT CODES New 2012 92071 Fitting of contact lens for treatment of ocular surface disease Report supply of lens separately with 99070 or V code

CPT CODES New 2012 92072 Fitting of contact lens for management of keratoconus , initial fitting Report supply of lens separately with 99070 or V code Subsequent fittings, report 99 or 92 office call code

Remote Imaging New in 2011 Remote imaging for detection of retinal disease and Remote imaging for monitoring and management of active retinal disease

Remote Imaging New in 2011 92227 Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral.

Remote Imaging 92227 This code has no physician work and is intended for use by non-physician readers For detection or screening for retinopathy Used when it is unknown if patient has retina disease - just looking for it

Remote Imaging New in 2011 92228 Remote imaging for monitoring and management of active retinal disease (eg, diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral.

Remote Imaging 92228 When patient has active retinopathy being managed For physicians involved with remote imaging

Remote Imaging 92228 example Separate entity (eg reading center) owns imaging system It is placed in PCP office PCP staff takes image

Remote Imaging 92228 example Image is sent to OD/OMD for I&R Reading center staff provides I&R, under physician supervision PCP bills w/ TC, OD/OMD/Reading center bills w/ 26

Remote Imaging 92228 example 92228-26 $21.43 (Medicare 2013)

Deleted CPT 92120 Tonography; recording indentation tonometer or perilimbal suction   92130 Water provocation tonography

ICD-10 ICD-10-CM October 1, 2014 implementation

ICD-10 ICD-10-CM “Benefits” Measure quality, safety, efficacy of care Reduce need for attachments to explain pt’s condition Design payment systems & process claims for payment Conduct research, epidemiological studies, clinical trials Setting health policy Operational and strategic planning Designing health care delivery systems Monitor resource use Improve clinical, financial, administrative performance Prevent and detect health care fraud and abuse Track public health and risks

TearLab Osmolarity Test Waived Test Approval Effective January 1, 2012 CMS pays 83861 in each state $23.25 per eye

DMEPOS Fee January 1, 2013 application fee for CMS 855S for enrollment or revalidation with DME is $523 Fee will remain $532 until December 31, 2013 (was $505, $523)

DMEPOS Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Can you sell post cataract glasses if not a provider?

Medicare CF Conversion Factor 34.023 January 1, 2013 to December 31, 2013

Medicare ABN Advanced Beneficiary Notice ABN Form CMC-R-131 (03/11) Only acceptable version after January 1, 2012

LCD file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/LCD/LCD Aug 13.pptx