1. 2014 CODING UPDATE

2. 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)

3. 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 ( ) -12% ($134)
Photo, External (92285) -14% ($21)
Visual Field, Extnd. (92083) -26% ($67)
Photo, Specular Micrscpy (92286) -69% ($39)

4. 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.

5. 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.

6. Amniotic Membrane
Bio-Tissue PROKERA

7. 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 V they have no LCD for OCT.

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

9. Medicare MEDICARE PAYMENT REDUCTION PROGRAMS:
OPPS, MPPR, SEQUESTRATION

10. 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 Fundus Photography.

11. 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).

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

13. 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

14. Medicare MPPR – 92250 Photo, fundus 92285 Photo, external
92286 Photo, specular endothelial microscopy
file://localhost/Users/alanhomestead/Documents/My Documents B /Adventures /1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee xlsx

15. 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 /Adventures /1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee xlsx

16. GLAUCOMA STAGE ICD CODES

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

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

19. 365.23 Chronic angle-closure glaucoma
Corticosteroid-induced glaucoma, glaucomatous stage
Pseudoexfoliation glaucoma
Glaucoma associated with ocular inflammations
Glaucoma associated with vascular disorders
Glaucoma associated with ocular trauma

20. Select Glaucoma Stage code (physicians judgment)
Glaucoma stage, unspecified
No documentation regarding stage of glaucoma
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

21. 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
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

22. Glaucoma stage cannot be determined
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 with which is no documentation regarding stage of glaucoma

23. 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

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

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

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

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

28. INFORMATION Teaching tool by AGS Google “American Glaucoma Society”
Google “American Glaucoma Society”

29. CPT CODES
Deleted Fitting of contact lens for treatment of disease, including supply of lens

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

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

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

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

34. 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

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

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

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

38. 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

39. Remote Imaging
92228 example $21.43 (Medicare 2013)

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

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

42. 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

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

44. 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)

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

46. Medicare CF
Conversion Factor January 1, 2013 to December 31, 2013

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

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