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Corcoran: New changes in the 2016 ophthalmic practice environment
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WAIKOLOA, Hawaii — Kevin J. Corcoran, COE, CPC, FNAO, highlighted new changes in the ophthalmic practice environment in 2016 here at Hawaiian Eye.
In 2015, there was a ruling for corneal tissue reimbursement that stated those using corneal tissue as a patch graft would receive a reimbursement separate from facility fee, he said.
Kevin J. Corcoran
In 2016, the only separate reimbursement for corneal tissue was keratoplasty.
“If you are using corneal tissue in other applications, it is simply treated as a part of the facility fee,” Corcoran said.
On July 1, 2015, new category III code 0402T for collagen corneal cross-linking was released, which includes removal of the corneal epithelium and intraoperative pachymetry when performed. The code was effective January 1, 2016.
“This code is already covered by Aetna. I imagine that some other payers will do so as well,” Corcoran said.
New HCPCS code J7313 was added for Iluvien (Alimera Sciences), he said.
“The description [for Iluvien] says 0.01mg, but the dosing is 0.19 mg, which means you have to use 19 units on the claim. That makes a big difference because it is about $500 a unit,” he said.
Effective on July 1, 2015 to December 31, 2015, Centers for Medicare & Medicaid Services (CMS) required the use of Q9977 to identify any compounded drug including Avastin (bevacizumab, Genentech). Q9977 was supposed to take the place of J3490 and J3590, he said.
CMS changed the HCPCS code on January 1, 2016.
“J7999 now takes the place of the Q9977 code, has the exact same purpose, has the exact same effect and it is important that you begin using this now,” he said.
CMS has added four level II modifiers that include XE for separate encounter, XS for separate structure, XP for separate practitioner and XU for unusual non-overlapping service.
“Having said that, I can tell you that you are supposed to be using these modifiers instead of modifier 59 unless you can think of a special reason to use it,” he said.
From the Medicare Part B program, ophthalmology received $2.7 billion for supplies, which only entails two things: Lucentis (ranibizumab, Genentech) and Eylea (aflibercept, Regeneron), Corcoran said.
“In 2014, supplies were at $0; they did not exist. Now it is 30% of everything ophthalmologists get paid,” he said.
According to Corcoran, the areas of scrutiny in ophthalmology are eye exams; imaging; drugs; modifiers 22, 24, 25; cataract surgery and treatment of wet age-related macular degeneration.
“If you want to go home and tell your officer manager, administrator or compliance officer where we need to pay special attention, there is your shopping list,” Corcoran said. – by Nhu Te
Reference:
Corcoran K. What’s new in 2016? Presented at: Hawaiian Eye 2016 meeting; Jan. 17, 2016; Waikoloa, Hawaii.
Disclosure: Corcoran reports he is consultant for Corcoran Consulting Group.