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Ophthalmic industry growing despite static reimbursements

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WAILEA, Hawaii – The “good news” in 2015 is that ophthalmology is a growth industry, according to Kevin J. Corcoran, COE, CPC, FNAO.

Kevin J.
Corcoran

“Your skills, your talent, your ability is in huge demand, and it’s only getting bigger,” he said, speaking at the Hawaiian Eye 2015 meeting. Even though reimbursement rates have been static and the supply of ophthalmologists is not increasing, the demand for ophthalmologists’ services continues to increase with the aging of the “baby boomer” cohort.

“It is good to be you,” he jokingly told the audience.

There have been about a dozen changes in current procedural technology (CPT) codes that will affect ophthalmology practices in 2015, he said. Among them are category III, or temporary new technology codes, for quantitative pupillometry, drug-eluting implants, visual field assessment with telemedicine and computer animation of retinal fundus photos.

“What is interesting here is that 0376T is a brand new code for a supplemental stent. This is the iStent [Glaukos] procedure, and if you put in one, you use [code 0191T]; if you put in two, you use both codes,” Corcoran said.

For the new “dropless” cataract surgery product, Omidria (phenylephrine 1.0%/ketorolac 0.3%, Omeros), ophthalmologists should use the new Healthcare Common Procedure Coding System code C9447, he said.

Citing CMS clarification regarding payment for this “dropless” surgery, Corcoran said that this option is available for cataract surgeons, but no separate payment will be made: “Injections are a part of the ocular surgery and are included as a part of the ocular surgery and the HCPCS code used to report the surgical procedure.”

Every year Corcoran reports on the top 10 ophthalmic procedures based upon the Medicare Utilization Patterns for ophthalmology based upon CMS data, and this Hawaiian Eye was no different. The top 10 ophthalmic procedures are: intravitreal injection; cataract w/IOL; YAG capsulotomy; punctum plug; epilation; complex cataract; laser trabeculoplasty; blepharoplasty; focal laser; and laser peripheral iridotomy. – by Patricia Nale

Disclosure: Corcoran is president of Corcoran Consulting Group.