Practice patterns do not remain constant, so comparing year-over-year is always worthwhile. When we compare Medicare data for 2016, the most recent year currently available, with the prior year (2015), we see some interesting things.

Q. Were there large changes for diagnostic tests?

A. There were. Table 1 shows some of the most dramatic increases for ophthalmology. Table 2 shows some of the most significant decreases.

In many cases, the actual frequency is low, but the percentage changes are large, such as immunoassay, a lab test for dry eye. For other codes, the percentage changes are modest, such as for OCT of the retina, but the sheer volume makes it important.

Q. How about surgical procedures?

A. For ophthalmic surgery, Table 3 identifies the big changes in utilization, both up and down.

It is no surprise that the number of minimally invasive glaucoma surgery (MIGS) procedures continues to increase. The only code with any history is 0191T (iStent). Although other devices are being used now, they are new and no data yet exist.

The frequency of intravitreal injections continues to rise. It is currently the most common ophthalmic procedure, surpassing even cataract surgery. As with the related OCT of the retina, shown in Table 1, the percentage change is not great, but the volume is important.

We also looked at the use of supplies, especially injectable medications. Table 4 shows the relative volume of these supplies year-over-year. Note particularly the two largest numbers — aflibercept (Eylea, Regeneron) and ranibizumab (Lucentis, Genentech). You can readily see the growth in use of Eylea, while Lucentis’ declined, although not as much — use of these drugs continues to increase overall. Interestingly, although the data are less obvious, we can also see a decline in utilization of Avastin, which is reported with various miscellaneous J-codes.

Q. Were there significant changes in exam coding?

A. Yes, although not as dramatic as those for tests and procedures. Table 5 shows these numbers. The overall frequency of exams paid by Medicare decreased a bit. The only segment to increase was established patient eye codes; evaluation and management (E/M) code frequency decreased across the board, as did new patient eye codes.

If your practice patterns vary considerably from the average, in all categories of codes, you face increased risk of unwanted attention. Keep in mind that careful documentation of both the service and its medical necessity is your best defense. OM

*Dysport, Ipsen Biopharmaceuticals, Inc; Xeomin, Merz North America, Inc.; Eylea, Regeneron Pharmaceuticals, Inc.; Ozurdex, Allergan, Inc.; Kenalog, Bristol-Myers Squibb Co.; Lucentis, Genentech USA, Inc.; Avastin, Genentech USA, Inc.; iStent, Glaukos Corp.

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