HCFA improves three ophthalmic codes
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WASHINGTON — The Health Care Financing Administration (HCFA) has revised some of the work relative value units (RVUs) that directly impact ophthalmologists during its mandated five-year review of RVUs. After reviewing values for nine ophthalmic services for possible cuts, the HCFA improved three of the codes and left the remaining six as is. The result will be published in the 2002 Medicare Fee Schedule.
The five-year review is a federally mandated process in which HCFA reviews the appropriateness of work values assigned to physician procedures. It holds huge potential for payment changes because work RVUs are a component of the Medicare equation that helps determine how much physicians get paid for services and represents 55% of the physician’s fee.
Changes occurred to CPT codes 67218, 92018, and 65855.
The work RVU for CPT code 67218 for treatment of retinal lesions will increase from 13.52 to 18.53 units, or to $191.67, to reflect complexity not considered in HCFA’s original value for the service. Code 92018 for an eye exam under anesthesia will be getting an additional $37.87 due to RVUs increasing from 1.51 to 2.5. HCFA dropped the global period for trabeculoplasty (CPT 65855) from 90 days to 10 days as some organizations had urged, but decreased the work value from 4.30 to 3.85 RVUs, resulting in a $17 decrease in payment for the actual procedure.
Despite the decrease in payment, the American Academy of Ophthalmology applauded the change in that code as well. The Academy argued that in many cases, complications during the 90-day period are due to unrelated pre-existing problems, which prior to this rule could not be billed for during the 90-day period.
The American Academy of Ophthalmology was among the organizations pushing for the changes.