This article is more than 5 years old. Information may no longer be current.
Practices face new Medicare payment structure, minimal coding changes
Repeal of the SGR prevented a 21% decrease in the Medicare conversion factor.
Click Here to Manage Email Alerts
This year, practices will receive Medicare reimbursement based on a new payment system and face a few coding changes that may affect their bottom lines, according to a leading practice management consultant.
Kevin J. Corcoran, COE, CPC, CPMA, FNAO, discussed Medicare reimbursement and CPT codes at Hawaiian Eye 2015.
This spring, Congress passed a bill that repealed the SGR formula, a key factor in annual Medicare physician payment updates for 18 years. The bill ensures a 0.5% annual physician payment update through 2019 and creates a Merit-Based Incentive Payment System (MIPS).
Aside from changes to the payment system, the Medicare Physician Fee Schedule (MPFS) does not contain many surprises for ophthalmologists, Corcoran said.
Changes and additions to CPT codes will affect some subspecialties more than others.
MIPS, conversion factor, RVUs
The MIPS consolidates the three current Medicare incentive programs: Physician Quality Reporting System, Value-Based Payment Modifier and Meaningful Use of electronic health records.
The SGR repeal bill prevented a 21% decrease in the Medicare conversion factor, from $35.8228 to $28.2239, Corcoran said in a subsequent interview with Ocular Surgery News.
Corcoran said that the conversion factor has not changed significantly in almost 2 decades and that it constitutes an important part of the MPFS. The Geographic Practice Cost Indices and the Relative Value Units (RVUs) make up the rest of the MPFS formula.
RVU changes for certain CPT codes took effect on Jan. 1.
“A few are a pretty good size. For example, scleral reinforcement with graft (67255) decreased 23% and pars plana vitrectomy with removal of internal limiting membrane (67042) decreased 26%. RVUs for most other ophthalmic CPT codes changed very little. Taking ophthalmology as a whole, RVUs were mostly unchanged,” Corcoran said.
The largest decrease in RVUs was pars plana vitrectomy with endolaser PRP (29%).
CMS corrected an error in malpractice RVUs, resulting in a roughly 1% to 2% reduction for ophthalmologists, Corcoran said.
Corcoran noted that ASC-11, a new quality measure, was changed to make reporting by ASCs on cataract surgery visual outcomes voluntary rather than mandatory. “That’s a big plus,” he said.
New and revised codes
Corcoran said several changes, additions and deletions in the American Medical Association’s CPT handbook will affect ophthalmology practices this year.
Noteworthy additions and revisions include 66179/66180 (aqueous shunt to extraocular equatorial plate reservoir, external approach, without graft and with graft) and 66184/66185 (revision of aqueous shunt to extraocular equatorial plate reservoir, without graft and with graft).
New category III codes include visual field assessment with real-time data analysis (0378T), technical support and patient instructions, surveillance, analysis and transmission of daily and emergent data reports (0379T), and computer-aided animation and analysis of time series retinal images (0380T).
“Category III of CPT includes temporary codes for emerging technology, services and procedures,” Corcoran said. “These codes pose administrative challenges for billers and coders because they are not usually reimbursed.”
The Healthcare Common Procedure Coding System code C9447 should be used for the new cataract surgery product Omidria (phenylephrine 1.0%/ketorolac 0.3%, Omeros).
The adoption of new ICD-10 codes was delayed to Oct. 1, Corcoran said. – by Matt Hasson
- For more information:
- Kevin J. Corcoran, COE, CPC, CPMA, FNAO, can be reached at Corcoran Consulting Group, 560 East Hospitality Lane, Suite 360, San Bernardino, CA 92408; email: kcorcoran@corcoranccg.com.
Disclosure: Corcoran is president of Corcoran Consulting Group.