Reimbursement Status for New Products
You can file claims when you use many of these next-generation technologies.
BY KEVIN J. CORCORAN, COE, CPC, FNAO

Several exciting new ophthalmic products have been introduced recently, including some at the American Academy of Ophthalmology meeting in Anaheim. In this article, I'll briefly review these advances in technology along with their reimbursement implications.

The Oculus Pentacam

Pentacam 3-D Camera

Oculus' new Pentacam camera provides the user with the ability to view, photograph and measure the anterior segment of the eye without invasive operation or direct contact with the cornea.

The rotating camera provides three-dimensional images of the anterior segment of the eye. It performs corneal topography of the front and back surfaces of the cornea, pachymetry anywhere on the cornea, and will measure height, volume and diameter of the anterior chamber (and any measurement of the anterior segment). In addition, the Pentacam provides the anterior chamber angle in degrees, images the lens, and objectively indicates if there is any opacity and how much. It also generates tomographic images from the anterior corneal surface to the posterior capsule of the lens.

This multipurpose device permits the user to claim reimbursement for a variety of procedures including:

• external ocular photography (CPT 92285)
• corneal topography (CPT 92499, HCPCS S0820)
• optical corneal pachymetry (CPT 92499)

As you know, CPT 92499 is used to describe an unlisted ophthalmological service and isn't specifically assigned to either corneal topography or optical corneal pachymetry.

The Pentacam is manufactured by Oculus Optikgeraete GmbH in Wetzlar, Germany. It's sold in North America by Oculus Inc. Web site: www.oculususa.com.

ObjectiVision's AccuMap

AccuMap Objective Perimetry

ObjectiVision's AccuMap is a patient- and practitioner-friendly objective perimeter that enhances the detection and monitoring of changes in the visual field due to retinal deterioration or optic nerve degeneration.

AccuMap uses multifocal objective perimetry (MOP) to produce an objective measure of visual field loss. Recording the activity of the visual cortex in response to stimulation of the localized areas of the visual field has the potential for diagnosis and management of various ophthalmic and neurological disorders, specifically glaucoma.

Subjective perimetry requires patient responses to determine visual thresholds for various points in the field. It's currently used as the gold standard for detection of visual field defects. However, it's acknowledged in the literature that subjective perimetry has several inherent problems such as a learning curve, and patient fatigue during the test. In comparison, objective perimetry requires no decision-making by the patient and therefore, by its nature, isn't affected by a learning curve. Many patients who are unable to perform reliable subjective tests can perform the MOP technique because it doesn't involve decision-making and is less stressful.

There are three levels of visual field testing according to CPT: 92081 (limited, single stimulus), 92082 (intermediate, suprathreshold), and 92083 (extended, threshold). The results of objective perimetry with AccuMap are most nearly akin to threshold perimetry, which is the most common form of visual field testing, particularly for glaucoma.

The AccuMap is a product of ObjectiVision Pty of Australia and distributed by Heidelberg Engineering in the United States. Web site: www.objectivision.com.

Nidek's MP-1

MP-1 Multipurpose Diagnostic Instrument

Nidek's MP-1 is a multipurpose instrument that's capable of fundus photography, perimetry and fixation exam. It's particularly appealing to clinicians who frequently deal with macular degeneration.

Reimbursement for fundus photography (92250) and perimetry (92081, 92082, 92083) are well described in CPT and the payment policies of third-party payers. A fixation exam is a unique test that's performed to assess the quality of fixation, as well as the anatomical location of the fixation point in patients with amblyopia, low vision or retinal disease that requires perifoveal photocoagulation. No specific CPT code exists to describe this test. We consider it an incidental component of an eye exam or consultation.

The MP-1 is manufactured by Nidek Technologies Srl in Padova, Italy, and sold by Nidek Technologies America, Inc. in the United States. Web site: www.nidektech.com.

The Optos Panoramic200

Panoramic200: Funduscopy Without Dilation

The Optos Panoramic200 scanning laser ophthalmoscope takes high-resolution color, ultra-widefield, digital images of nearly the entire retina through an undilated pupil using red and green laser wavelengths. The resultant digital image, termed the Optomap, can be easily reviewed with the patient. The high-quality images of the Optomap are a valuable aid in the early detection or monitoring of diseases or disorders that manifest in the posterior pole of the eye. Once in the computer environment, the image may be magnified, measured, manipulated, printed, and stored as desired. It may also be transmitted to other physicians as a part of the medical record.

If a separate charge will be made for the Optomap retinal exam on the same day as an office visit, the most appropriate CPT code to describe this test is 92250, fundus photography with interpretation and report. Medicare defines this code as bilateral, meaning that one payment will be made for testing both eyes. Although the Optomap digital output provides more detail than a traditional fundus photograph, including linear and area measurements, it currently lacks quantitative measurements in the Z-axis, such as retinal thickness, that are the hallmark of other scanning laser ophthalmoscopes. Consequently, when choosing between 92135 (scanning computerized ophthalmic diagnostic imaging) and 92250, we select the code where all of the requirements are firmly met.

The Panoramic200 is manufactured by Optos plc in Dunfermline, Scotland, and distributed by Optos North America in the United States. Web site: www.optos.com.

eyeonics' Crystalens

Crystalens Accommodative IOL

The Crystalens is an accommodative IOL FDA-approved for adults with cataract who would benefit from near, intermediate and far vision without the use of spectacles. The unique design of this IOL permits the optic to move back and forward within the capsular bag to provide a continuous full range of vision. This premium IOL is sold worldwide for the equivalent of about US$800.

Because of the cost of the Crystalens, hospitals and ASCs may be reluctant to purchase this lens for Medicare beneficiaries; cataract surgery reimbursement is $1,160 and $973 respectively. Some private insurers have indicated that the patient may pay for the "deluxe" portion of the Crystalens. Under the present Medicare program's instructions to providers, Medicare regulations don't permit "balance billing" by the hospital or ASC for any portion of the cost of an IOL. Patients may be held responsible only for the usual co-payment and deductible amounts. Regulations also prohibit a beneficiary from purchasing the lens from the surgeon for later implantation.

A Medicare beneficiary may obtain the Crystalens as part of a non-covered procedure and pay out-of-pocket. For example, if the beneficiary requests surgery for an incipient cataract that doesn't meet the medical necessity guidelines for Medicare payment, the cataract surgery wouldn't be covered by Medicare. Both the surgeon and the facility should obtain an Advance Beneficiary Notice (ABN) documenting the beneficiary's agreement to pay. Submit the claim with modifier GA appended to the CPT code for the procedure.

The Crystalens is manufactured and distributed by eyeonics, inc., in the United States. Visit the company's Web site at www.eyeonics.com.

Additional Information

The Corcoran Consulting Group has prepared a comprehensive discussion of reimbursement considerations for each of these products. For a free copy, contact the manufacturer or the Corcoran Consulting Group help@corcoranccg.com or call (800) 399-6565.

Kevin Corcoran is president of Corcoran Consulting Group, located in San Bernadino, Calif.