2014 CODING
UPDATE
1
Increases
EM office visits (99xxx)
Ophthalmic office visits (92xxx)
Ext. Ophthal. (92225/6)
Topography (92025)
Foreign Body, Conj. (65205)
Cornea puncture, tattoo (65600)
Probe canaliculi (68840)
RVU (Medcr)
+3%
+6%
+5% ($28/$25)
+6% ($38)
+6% ($58)
+6% ($411)
+7% ($135)
2
Decreases
Fundus Photo (92250)
Cornea FB w/SL (65222)
Fit CL for ocl. surface dx (92071)
Cat. Sx. w/ IOL (66984-55)
Photo, External (92285)
Visual Field, Extnd. (92083)
Photo, Specular Micrscpy (92286)
RVU (Medcr)
-6% ($81)
-7% ($70)
-10% ($34)
-12% ($134)
-14% ($21)
-26% ($67)
-69% ($39)
3
Amniotic Membrane
65778 Placement of of amniotic membrane on
the ocular surface for wound healing; selfretaining
Recurrent corneal erosion,
infectious/inflammatory keratitis, herpes,
superficial epithelial defects, severe dry eye,
cornea disease.
4
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.
5
Amniotic Membrane
Bio-Tissue
PROKERA
www.biotissue.com
6
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.
7
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.
8
Medicare
MEDICARE PAYMENT REDUCTION
PROGRAMS:
OPPS, MPPR, SEQUESTRATION
9
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.
10
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).
11
Medicare
MPPR –
The first diagnostic procedure is paid at the
normal rate. The first diagnostic procedure is
defined as the one with highest value.
12
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
13
Medicare
MPPR –
92250 Photo, fundus
92285 Photo, external
92286 Photo, specular endothelial microscopy
file://localhost/Users/alanhomestead/Documents/My Documents B 3-813/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee
2013 15.4.xlsx
14
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
15
Files XLSX/1 AccuFee 2013 15.4.xlsx
GLAUCOMA STAGE ICD CODES
16
Using Glaucoma Stage Code
Select ICD code for type of glaucoma (same
as past) from 38 glaucoma codes (365.xx)
17
If selected code is one of 11 (below), add
Glaucoma Stage code in 2nd position on claim
form
365.10
365.11
365.12
365.13
365.20
Open-angle glaucoma, unspecified
Primary open angle glaucoma
Low tension glaucoma
Pigmentary glaucoma
Primary angle-closure glaucoma, unspecified
18
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
19
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
20
365.72 Moderate 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
21
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
22
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
23
Claim Form
Enter stage code adjacent to glaucoma diagnosis
Report with office visit code and every related
procedure done during visit
24
Secondary Codes
Glaucoma stage codes are secondary add-on
codes
Glaucoma stage codes are not principal or firstlisted or primary diagnosis codes
25
HIPAA
Adherence to ICD guidelines is required by HIPAA
HIPAA applies to anything transmitted
electronically
Some plans may be slow to recognize new codes
26
PAYMENT IF NOT REPORTED?
Florida MAC says Yes
Noridian?
WPS?
Non-Medicare?
27
INFORMATION
Teaching tool by AGS
http://www.americanglaucomasociety.net/professional
s/glaucoma_staging_codes_teaching_module/
Google “American Glaucoma Society”
28
CPT CODES
Deleted 2012
92070
Fitting of contact lens for treatment of disease,
including supply of lens
29
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
30
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
31
Remote Imaging
New in 2011
Remote imaging for detection of retinal disease
and
Remote imaging for monitoring and management
of active retinal disease
32
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.
33
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
34
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.
35
Remote Imaging
92228
When patient has active retinopathy being
managed
For physicians involved with remote imaging
36
Remote Imaging
92228
example
Separate entity (eg reading center) owns imaging
system
It is placed in PCP office
PCP staff takes image
37
Remote Imaging
92228
example
Image is sent to OD/OMD for I&R
or
Reading center staff provides I&R, under
physician supervision
PCP bills w/ TC,
OD/OMD/Reading center bills w/ 26
38
Remote Imaging
92228
example
92228-26 $21.43
(Medicare 2013)
39
Deleted CPT
92120 Tonography; recording indentation
tonometer or perilimbal suction
92130 Water provocation tonography
40
ICD-10
ICD-10-CM
October 1, 2014 implementation
41
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
42
TearLab Osmolarity Test
Waived Test Approval
Effective January 1, 2012
CMS pays 83861 in each state $23.25 per eye
43
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)
44
DMEPOS
Durable Medical Equipment, Prosthetics,
Orthotics, and Supplies
Can you sell post cataract glasses if not a
provider?
45
Medicare CF
Conversion Factor
34.023
January 1, 2013 to December 31, 2013
46
Medicare ABN
Advanced Beneficiary Notice
ABN Form CMC-R-131 (03/11)
Only acceptable version after January 1, 2012
47
LCD
file://localhost/Users/alanhomestead/Docu
ments/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
48