As with every new year, coding and reimbursement have undergone some important changes for 2018. Now that everything is finalized, here are some issues you need to know:

Q. What coding changes will we see in 2018?

A. CPT has some new codes, revisions and deletions that are applicable to ophthalmology. Most of the Category I changes in eye care affect oculoplastics.

New codes:

• 15730 - Midface flap (i.e., zygomaticofacial flap) with preservation of vascular pedicle
• 15733 Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (e.g., buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)

A revised 2018 Category I code is listed below. Added language is underlined and the deleted language noted via

strikethrough:

• 95930 – Visual evoked potential (VEP) checkerboard or flash testing, central nervous system except glaucoma, checkerboard or flash, with interpretation and report

Remember that when a VEP is indicated with glaucoma, the code required is Category III code 0464T, Visual evoked potential testing for glaucoma, with interpretation and report. This code was new for use in January 2017.

A Category I code also has been deleted:

• 15732 - Muscle, myocutaneous, or fasciocutaneous flap; head, and neck (e.g., temporalis, masseter muscle, sternocleidomastoid, levator scapulae)

Category III codes underwent some changes as well. These codes are released semiannually by the AMA. Those suitable for use since July 1, 2017 are:

• 0469T - Retinal polarization scan, ocular screening with on-site automated results, bilateral
• 0472T - Device evaluation, interrogation, and initial programming of intra-ocular retinal electrode array (e.g., retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional
• 0473T - Device evaluation and interrogation of intra-ocular retinal electrode array (e.g., retinal prosthesis), in person, including reprogramming and visual training, when performed, with review and report by a qualified health care professional
• 0474T - Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space

Q. Are there changes to HCPCS?

A. On Dec. 31, 2017, pass-through payment for C9447 (phenylephrine and ketorolac, injection) expired. The CMS Final Rule shows a payment indicator for this code changed from “K2” (paid separately) to “N1” (bundled). This means that as of Jan. 1, 2018, payment for C9447 is packaged in the reimbursement for the cataract procedure and it is no longer separately identifiable for Part B Medicare. You may not use an ABN or similar financial waiver form to shift payment responsibility to the Medicare beneficiary. Other third-party payers will likely adopt CMS’ policy, although they are not required to.

In May 2017, a request was submitted to CMS for a new HCPCS J-code: “JXXXX Riboflavin 5’-phosphate, with or without dextran, ophthalmic solution, FDA-approved final product, non-compounded, up to two 3 mL syringes, single patient use”. HCPCS reached a final decision in Nov. 2017: “This request to establish a new Level II HCPCS code to separately identify Photrexa has not been approved, because this product is an integral part of a procedure, and payment for that service includes payment for Photrexa, if it is used.”

As a result, only CPT 0402T (collagen cross-linking of cornea including removal of the corneal epithelium and intraoperative pachymetry when performed) should be submitted on claims for this procedure.

Q. What happened with the Medicare Physician Fee Schedule as of Jan. 1?

A. The 2018 Medicare Physician Fee Schedule (MPFS) was published in the Federal Register on Nov. 15, 2017.¹ 2018 is the third year since the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA provided a 0.5% update to physician payments under Medicare for five years. The 2018 MPFS conversion factor is $35.9996, up slightly from $35.8887 in 2017. This includes a budget neutrality adjustment of -0.10% and the aforementioned MACRA update of 0.5%, and a misvalued code reduction target adjustment of -0.09%.

While most Medicare payments remained largely unchanged, the relative value units for some codes did change significantly. Of the 622 codes that apply to ophthalmologists in 2018, only 42 have a reimbursement change of more than 3%. Of those codes with significant changes (>3%), 19 had positive changes; 23 had negative changes. Table 1 lists some of those codes with the largest changes. OM

REFERENCE

1. Federal Register. 11/15/17. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2018; Medicare Shared Savings Program Requirements; and Medicare Diabetes Prevention Program. https://www.federalregister.gov/documents/2017/11/15/2017-23953/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions . Accessed Dec. 21, 2017.

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