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CMS selects several high-volume ophthalmology codes for value review
An AMA committee will make a recommendation to CMS on increasing or decreasing the codes’ values.
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More than two dozen ophthalmic codes have been selected by the Centers for Medicare and Medicaid Services for reevaluation, including some codes for high-volume procedures, according to the American Academy of Ophthalmology.
A committee of the American Medical Association will review the relative value of 29 ophthalmic codes and advise the CMS on whether they are overvalued or undervalued.
Fifteen of the codes were suggested to the CMS by the AAO as being undervalued. The CMS decided to review an additional 14 codes that it believes may be overvalued, according to the AAO. Any change in the relative value of the codes could mean an increase or decrease in reimbursement for those Medicare-covered services.
Among the codes the CMS has opted to review are those for such high-volume ophthalmic procedures as YAG capsulotomy (66821) and cataract with IOL (66984), the AAO said. Other high-volume procedures, such as retinal incisional and laser surgery codes, have also been selected for review.
“A 1990 law requires CMS to comprehensively review all physician relative work values at least every 5 years and make any needed adjustments. The review is important to all of medicine because Physician Work Relative Value Units constitute 53% of any code’s payment,” the AAO release said.
The CMS will submit the codes in question to a physician panel of the AMA that decides on the relative value of the physician work involved in the coding procedures. Once those codes are reviewed, a recommendation is made to CMS.
The CMS will publish a proposed rule on the revaluations by spring 2006, according to the AAO. Final values will be published by November 2006 and implemented in January 2007, the press release said.
The AAO has pledged to fight the issue should the review result in lowered reimbursement rates.
Codes reviewed again
This is the third time CMS has done a 5-year review and the third time it has selected ophthalmic codes to review since the system began in 1995, according to the AAO. Some of the ophthalmic codes in the current review, including cataract/IOL and YAG capsulotomy, are being targeted a second time, according to the press release.
Hundreds of codes from all of medicine have been selected for review, said Michael X. Repka, MD, secretary of federal affairs for the AAO.
“With all the codes that have never been included in a 5-year review, we question why CMS targeted some ophthalmology codes that have already been reviewed through this process,” Dr. Repka said.
The purpose of the periodic reviews is to revalue services that may have gotten easier or harder to deliver, Dr. Repka said in an interview with Ocular Surgery News. Normally, when the CMS selects codes for review, it is because they believe the codes are overvalued, he said.
“The [codes] we submitted are the ones we claim as undervalued. The ones [CMS] submitted, they would submit as overvalued. … They have one mission and we have another,” Dr. Repka said.
In past 5-year reviews, ophthalmic codes have fared well, Dr. Repka said. The AAO successfully defended the values of the codes, and as a result, the values of YAG capsulotomy and cataract with IOL were increased rather than decreased, he said.
For Your Information:
- Michael X. Repka, MD, can be reached at 233 Wilmer Institute, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21287-9028; 410-955-8314; fax: 410-955-0809.
- Jeanne Michelle Gonzalez is an OSN Staff Writer who covers all aspects of ophthalmology, specializing in practice management, regulatory and legislative issues. She focuses geographically on Latin America.