New codes bundle cataract removal and ECP
The codes, scheduled for 2020, are now in effect.
By Robert Stoneback, associate editor
Two new codes, which bundle together cataract removal and endoscopic cyclophotocoagulation (ECP), took effect at the start of 2020. The new codes, created by the American Medical Association’s CPT editorial panel, are 66987 (complex cataract removal with ECP) and 66988 (routine cataract removal with ECP). Both were scheduled to take effect on Jan. 1, 2020.
The change follows an RVS Update Committee report in October 2017, which found that CPT Codes 66711 (ECP) and 66984 (cataract removal) were “reported together 75% of the time or more” (https://tinyurl.com/wp2ajhd ).
While the payment for the new codes to the physician will be determined by the local carrier (MAC priced), the national average reimbursement for both ASCs and hospital outpatient departments (HOPDs) have increased, says Paula Ender, global product manager for Beaver-Visitec International (BVI). BVI manufacturers the E2 Ophthalmic Laser Endoscopy System. The average reimbursement to an ASC for the combined cataract and ECP procedure is now $2,393, an increase of approximately $930, according to Ms. Ender. The average reimbursement for the HOPD is $3,818, up from $1,917.
The previous ECP code of 66711 will only be used when performing ECP as a standalone procedure. ASC and hospital rates for 66711 have increased modestly; however, physician reimbursement will be reduced from $659 to $514.
CMS originally proposed a lower rate for the new codes, but during the codes’ 2019 public comment period, public responses stated that the proposed rates did not accurately reflect the cost for the combined procedures. This resulted in a “dramatic increase” in the reimbursement to hospitals and ASCs for the new codes, Ms. Ender says. OM
Ten smartphone apps to help ophthalmologists
A little digital assistance can create a more efficient and effective practice.
By Adi Mehta, MD
Smartphones are a ubiquitous part of modern day life. In fact, a 2017 study by global tech company Asurion found that Americans check their phones once every 12 minutes. However, behind that glossy screen lies a supercomputer able to deliver innovative apps that can help enhance your clinical practice.
In this article, I will highlight 10 smartphone apps that I use to streamline my practice, particularly in three distinct clinical areas: reference materials, examination tools and patient education (or, more aptly, patient empowerment tools). All apps are available on both Apple and Android devices, unless otherwise noted.
REFERENCE MATERIALS
- Inkling: This interactive eBook platform enables you to download two of the most referenced ophthalmological guidebooks: “The Wills Eye Manual” and “The Massachusetts Eye and Ear Infirmary Illustrated Manual of Ophthalmology.” These books are seamlessly integrated to allow for quick searching of diagnoses. [App is free; purchase of eBooks required]
- AAO eBooks (“Basic Techniques of Ophthalmic Surgery”): The AAO eBooks app lets you access many different reference books. One of the most useful books to use it with is “Basic Techniques of Ophthalmic Surgery,” which contains hundreds of ophthalmological procedures that are described in a concise step-by-step format with illustrations of crucial points in the procedure. It also contains narrated, high-quality videos of each surgical procedure. I routinely reference this book before a procedure that I may not have done in a while to quickly refresh and re-affirm my surgical approach. [App is free; purchase of eBooks required]
- AAO Ophthalmic Education: This newly released app from the Academy contains summaries of breakthrough research, news articles and informative videos that are pertinent to your sub-specialty. Moreover, it has a fun “Dx This” challenge to test your clinical acumen. EyeWiki is also available through this app, with the addition of “The Wills Eye Manual” to follow in the future. [Free]
- OCTaVIA: This app contains many retinal diagnoses with the corresponding OCT of the macula. It provides a detailed description of the OCT findings as well as useful links to the AAO website for further reading. [Free; only available on Apple App Store]
EXAMINATION TOOLS
- Ullman Indirect: I use this application to take slit lamp photos of any disease finding that I may need to track over an extended period of time, such as corneal ulcers or pigmented lesions. You can take professional-level photos with the simple addition of an adapter that fits onto your phone and connects to one of the oculars of the slit lamp. The adapter costs approximately $10 on Amazon. [Free]
- ToriCam: This app takes a picture of hand-drawn corneal marks to ensure its proper alignment for a toric IOL. At times, I may be off by 2° to 4°, which allows me to recalculate the placement of the IOL. A similar application (TorEye) has been verified by Rahil Chaudhary, MBBS, who found the accuracy of such apps to be comparable to digital axis marking system like the Verion. [Free; only available on Apple App Store]
- Eye Handbook: An all-in-one app for the ophthalmologist on call in the emergency room, which allows you to check a patient’s visual acuity, color vision and even check for fluorescein staining by utilizing the blue light on the smartphone. [Free]
- Doximity: This app masks your personal cell phone number and instead displays your office phone number when calling patients. I typically use this app when calling to check up on my post-phaco patients in the evening when I’m at home. [Free]
PATIENT EDUCATION/EMPOWERMENT
- Retina Risk: This app provides patients with their 10-year risk of developing diabetic retinopathy given their current A1C level and blood pressure, while providing easy-to-understand preventative resources. I have found that when a numerical value is attached to the risk, the notion of developing diabetic retinopathy becomes less abstract, thus, motivating patients to adopt lifestyle changes. [Free]
- Glaucoma Notebook: This app tracks IOP and graphs the data as a trend line. It allows patients to clearly see their general progress towards control of the disease. The app allows patients to fill in notes along each data point (for example, if a drop was added or a procedure performed). This app greatly increases drop compliance with my patients, as it helps them interact and take ownership of the data that we as clinicians also use to make treatment decisions. [Free; only available on Apple App Store]
LETTER TO THE EDITOR
Dear Dr. Patterson,
Thank you so much for both your articles on operating room playlist tips, one from June on your favorite music to play during surgery (https://tinyurl.com/sckor8v ), and one from November on songs to avoid while operating (https://tinyurl.com/t8xwmp2 ). Since you shared your dos and don’ts for OR music, I thought I would share the song preferences at my practice, Stein Eye Center, of Santa Monica, Calif.
My time-enduring favorites for the OR have always been “In Your Eyes” by Peter Gabriel and “Smooth Operator” by Sade. When the going gets rough and posterior capsular integrity is at stake, I generally go to Enya’s “Caribbean Blue” to help restore calm to the OR. As for the do NOT playlist, I avoid “I Don’t Care Anymore” by Phil Collins.
On a more contemporary note (pun intended), these are some essential tunes in the musical armamentarium for special cases:
- Putting in a secondary IOL in a vitrectomized eye: “Blank Space” by Taylor Swift
- For spherical corneas with no cylinder: “(I’m in Love With the) Shape of You” by Ed Sheeran.
- When you have your best scrub tech and circulator: “The A Team” by Ed Sheeran
- In the event of a dropped nucleus, several tunes may be required, possibly in this order: “Skyfall” by Adele, “You Need to Calm Down” by Taylor Swift and “Rolling in the Deep” by Adele
- And, of course, suitable for either Venturi or peristaltic pumps: “(I’m a) Sucker (for You)” by the Jonas Brothers.
Thank you again for putting the “sound” in ultrasound. Music to my phaco ears!
Gavin G. Bahadur, MD
Santa Monica, Calif.
QUICK BITS
NIDEK launched the YC-200 Ophthalmic YAG Laser System in the United States, a successor to the company’s YC-1800 laser. The company also launched YC-200 s plus model, allowing for selective laser trabeculoplasty (SLT).
Aerie Pharmaceuticals acquired Avizorex Pharma (AVX), a Spanish opharmaceutical company that develops treatments for dry eye disease. Positive results from a Phase 2a study in 2019 support AVX’s lead product, AVX-012, as a dry eye treatment. A larger Phase 2b study is planned for late 2020.
Johnson & Johnson Vision launched the TECNIS Toric II 1-Piece IOL in the United States, the first product approved on the new TECNIS Toric II platform. The company will also launch two post-market clinical trials, conducted in up to 50 U.S. cities, to demonstrate rotational stability and visual outcomes.
Katena purchased Micro Medical Instruments (MMI). MMI was founded in 1990 and offers FDA-registered contract manufacturing services to the medical device industry; its products focus covers ophthalmic microsurgical instruments.
Eye Eco launched eyecloud, a moist heat therapy system designed to give dry eye patients sustained, relaxing relief. The eyecloud system was previously available in-office in the United States and is now available for patients at home. It uses reusable heat packs to provide 20 minutes of relief to the periocular region.
Horizon Therapeutics launched a new website and Facebook community, “Listen to Your Eyes,” designed to provide education and support for people living with thyroid eye disease (TED). The website, www.ThyroidEyes.com , was made with guidance from the TED community. TED is a rare, progressive and vision-threatening autoimmune disease.
REGENXBIO licensed the use of Clearside Biomedical’s proprietary, in-office SCS Microinjector; the injector is used for the delivery of adeno-associated virus-based therapeutics. REGENXBIO plans to use it as a delivery system for RGX-314, which is designed as a treatment for wet AMD, diabetic retinopathy and other conditions for which anti-VEGF treatment is the standard of care.
CooperVision received FDA approval for its MiSight 1 day, prescription contact lenses indicated to slow the progression of myopia in children age 8 to 12, the first FDA-approved myopia management contact lenses. Studies show MiSight 1 day slows progression by up to 59%. They are expected to be available in the United States in March 2020.
Zilia has released its Zilia Ocular fundus camera, which is able to provide measurement of oxygenation in the human eye. Zilia says this information can be used to help screen, assess and monitor diseases such as glaucoma, diabetic retinopathy and AMD.
In the article “The dry eye treatment paradigm” in our November 2019 issue, it was incorrectly stated that a Phase 3 clinical trial for Sun Ophthalmic’s Cequa cyclosporine medication showed clearing of corneal staining 48 days after initiation. Cequa showed clearing of corneal staining 28 days after initiation. Ophthalmology Management regrets the error.
![]({"src":"/media/henl5kow/cover_omd_0120.jpg","focalPoint":null,"crops":[{"alias":"thumbnail","width":1110,"height":700,"coordinates":null}]})