E-prescribing incentives, new CPT codes, procedure growth mean good news for ophthalmology

WAILEA, Hawaii — In 2009, physicians who use and report electronic prescribing in their practices will receive a 2% bonus. The incentive program is much friendlier to participate in than other Medicare programs, and a speaker here strongly recommended physicians participate.

Kevin J. Corcoran

Kevin J. Corcoran, COE, CPC, FNAO, OSN Practice Management Section Member, noted that the bonus rate is reduced to 1% in 2011 and 2012 and 0.5% in 2013. But more importantly, "unsuccessful reporters" will be penalized starting in 2012. The Medicare penalty schedule is -1% in 2012, -1.5% in 2013 and -2% in 2014 and all subsequent years, Mr. Corcoran reported here at the Hawaiian Eye 2009 meeting.

He also introduced to the meeting's audience new CPT codes for 2009.

These included Category 1 codes 65756 for keratoplasty (corneal transplant) and 65757 for backbench preparation of corneal endothelial allograft prior to transplantation.

Mr. Corcoran said these codes should answer surgeons' long-standing question, "How do we deal with DSEK?" They replace 65730, 65750 and 65755.

He said these are permanent codes. The code for keratoplasty should be used for the major procedure, has a relative value unit and has a fee schedule with allowable amounts. The code 65757 does not have a fee schedule and will be carrier dependent.

"The definitions are relatively simple. The major procedure is the first code. If you do the backbench prep, also use the second code," he said. "Nothing terribly tricky about this."

Mr. Corcoran also reported on the 2007 Centers for Medicare and Medicaid Services data on the top 10 ophthalmic procedures in Medicare.

Cataract surgery with IOL implantation remained No. 1. The second-ranked procedure is now intravitreal injection.

"Ladies and gentleman, give some real pause to No. 2, because if you think about this, this was not the case last year. And it is moving very quickly," Mr. Corcoran said.

He reported there were 800,000 intravitreal injections just in Medicare in 2007, making it the fastest growing segment of ophthalmology.

"Everything else pales in comparison," he said.

The top 10 list was rounded out by YAG capsulotomy, punctal occlusion with plugs, epilation, laser trabeculoplasty, focal laser, complex cataract surgery, panretinal photocoagulation and blepharoplasty.

He noted that complex cataract surgery moved up the ranking, "for which we probably have Flomax (tamsulosin, Boehringer-Ingelheim) to thank for." Also, trabeculectomy procedures were down.

He also reminded the audience that CMS has banned the use of signature stamps on medical records and on any written orders by physicians.

"The short answer is, throw them away," Mr. Corcoran said.