Coding & Reimbursement

New Year, New Coding Changes

By Suzanne L. Corcoran, COE

Medicare reimbursement changes fast and often. Here are some changes you can expect for 2013.

Q Are there CPT code changes in 2013?

A Yes, there are several affecting ophthalmology including revisions, deletions and additions. Coverage and payment for Category III codes remains at carrier discretion. Among the new codes are:

► 64615 — Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, trigeminal, cervical spinal and accessory nerves, bilateral (e.g., for chronic migraine).

► 0308T — Insertion of ocular telescope prosthesis including removal of crystalline lens.

Revised codes include (new text is italicized):

► 64612 — Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (e.g., for blepharospasm, hemifacial spasm).

► 65800 — Paracentesis of anterior chamber of eye (separate procedure); with diagnostic aspiration removal of aqueous.

► 67810 — Biopsy Incisional biopsy of eyelid skin including lid margin.

► 99174 — Ocular photoscreening with interpretation and report Instrument-based ocular screening (e.g., photoscreening, automated-refraction), bilateral.

Deleted codes for 2013 are:

► 65805 — Paracentesis of anterior chamber of eye (separate procedure); with therapeutic release of aqueous.

► 0173T — Monitoring of intraocular pressure during vitrectomy surgery.

There are also a couple of new HCPCS codes for injectibles:

► J7315 — Mitomycin, ophthalmic, 0.2mg.

► J0178 — Injection, aflibercept, 1mg.

The latter describes Eylea, and replaces the temporary Q2046. Bill as two units to claim appropriate reimbursement for the contents of the vial.

Q What about physician reimbursement rates?

A There is some bad news, I’m afraid. We will see reductions in Medicare allowables for several codes. Of particular interest:

► 66982, -25%.
► 66984, -12%.
► 67028, -9%.
► 92083, -29%.
► 92235, -6%.
► 92286, -70%.

2013 also sees the implementation of Medicare’s new Multiple Procedure Payment Reduction (MPPR), which reduces the allowable for many diagnostic tests when more than one test is performed at one patient encounter by the same physician or group. It only affects the technical component (TC) of the second or subsequent test. The reduction is 20% of the TC for the lesser-value test.

The list of tests includes ultrasounds, imaging and visual fields. Tests that do not have a technical component (e.g., gonioscopy) are not subject to this policy.

Q Are ambulatory surgery centers (ASCs) also taking a hit?

A No. In 2013, the ASC conversion factor and Multifactor Productivity Adjustment increase the ASC conversion factor by 0.6%. This results in a small, but positive, change to ASC facility reimbursement, although not as much as the hospital outpatient department increase of 1.8%.

Q Will we see changes to PQRS?

A Not really. The bonus remains at 0.5% of total Medicare allowed dollars for professional services. The nine ophthalmic measures in 2012 will continue in 2013.

CMS plans to use the 2013 reporting to determine whether you will be subject to a penalty in 2015. If you are not currently reporting PQRS measures, you should consider starting. In addition to line-item reporting on claims and registry reporting, in 2013 CMS is adding “administrative claims-based reporting.”

CMS will examine your claims history to determine quality of care, although just how this will be implemented has not yet been published.

Q What should we look at in 2013 for e-prescribing?

A There are minimal changes to e-prescribing in 2013. The bonus amount is reduced to 0.5%. The threshold is again 25 successful reportings during the 2012 calendar year.

Remember that you are not eligible for both the EHR bonus and e-prescribing bonus. If you have moved to electronic health records and plan to attest to “meaningful use” to earn that bonus in 2013, you still must report, via claims, at least 10 times in the first half of 2013 to avoid penalties in 2014 and 2015. OM

Suzanne L. Corcoran is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com.