You knew they were coming — coding and reimbursement changes await you each new year. So now that it’s January, what do we have to look forward to in 2017?

Q. What coding changes will happen in 2017?

A. There are a number of changes pertinent to ophthalmology, including one new Category I CPT code:

• 92242 Fluorescein angiography and indocyanine-green angiography (includes multiframe imaging) performed at the same patient encounter with interpretation and report, unilateral or bilateral

The following codes have changed descriptions:

• Δ 67101 Repair of retinal detachment, one or more sessions including drainage of subretinal fluid when performed; cryotherapy
• Δ 67105 Repair of retinal detachment, one or more sessions including drainage of subretinal fluid, when performed; photocoagulation
• Δ 92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral
• Δ 92240 Indocyanine-green angiography (includes multi-frame imaging) with interpretation and report, unilateral or bilateral

The changes to 92235 and 92240 are significant because until now, both codes were defined as unilateral. Medicare, as well as most other payers, consider “unilateral or bilateral” to mean bill once, whether one or both eyes are tested.

Deleted in 2017:

• 92140 Provocative tests for glaucoma, with interpretation and report, without tonography

The following new Category III codes are in effect as of Jan. 1.

• 0444T Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral
• 0445T Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including retraining, and removal of existing insert, unilateral or bilateral
• 0449T Insertion of anterior segment drainage device, without extraocular reservoir; internal approach, into the subconjunctival space
• 0450T … each additional device (List separately in addition to code for primary procedure)
  (For removal of aqueous drainage device without extraocular reservoir, placed into the subconjunctival space via internal approach, use 92499)
• 0464T Visual evoked potential, testing for glaucoma, with interpretation and report
  (For visual evoked potential screening for visual acuity, use 0333T)
• 0465T Suprachoroidal injection of a pharmacologic agent (does not include supply of medication)
  (To report intravitreal injection/implantation, see 67025, 67027, or 67028)

One Category III code has been redefined:

• Δ 0333T Visual evoked potential, screening of visual acuity, automated with report

Coverage and payment for Category III codes remain at the discretion of the Medicare Administrative Contractor.

Q. What changes are expected to the Medicare Physician Fee Schedule on Jan. 1?

A. The 2017 conversion factor is $35.8887, a slight increase from the 2016 conversion factor of $35.8043. This figure includes a budget neutrality adjustment of -0.013 — an increase of 0.5% resulting from MACRA and a misvalued code reduction target adjustment of -0.18%. Relative Value Unit (RVU) changes were expected to take effect Jan. 1.

The net result is an approximate 2% reimbursement reduction for ophthalmology services. Some retina and glaucoma procedure codes were revalued to the RUC’s (Relative Value Update Committee) original recommended RVUs after taking significant reductions in 2016. There were some significant changes, especially to physician work RVUs:

• Repair detached retina photocoagulation (67105) * - 59%
• Repair detached retina cryotherapy (67101) * - 58%
• Fluorescein angiography (92235) - 21%
• Fundus photography (92250) - 16%
• OCT optic nerve (92133) - 14%
• Trabeculoplasty (65855) - 10%
• Repair detached retina (67107) + 12%
• Glaucoma surgery (66170) + 13%
• Repair detached retina (67110) + 16%
• Corneal hysteresis (92145) + 19%

*These procedures change from major surgeries to minor surgeries with a 10-day global period as of Jan. 1.

Q. Are there changes for ASCs and HOPDs?

A. There are small increases in facility reimbursement in 2017. For ASCs, the wage adjustment for budget neutrality, along with the multifactor productivity adjusted update factor, increases the ASC conversion factor by 1.9% for those meeting the quality reporting requirements.

Various adjustments to hospital reimbursement result in a hospital outpatient department rate increase of 1.65%.

In 2017, CMS continues its policy that corneal tissue acquisition cost is only reimbursed to facilities when used in corneal transplant surgery.

Q. And beneficiary changes?

A. The Medicare Part B premium remains at $109 for most beneficiaries who get Social Security benefits (or higher based on income). The Part B deductible increases to $183, a $17 increase. OM