Ophthalmology and Optometry Coding Alert

If your practice uses indocyanine-green (ICG) angiography to enhance imaging of the eye's blood vessels, get ready for a nearly 10 percent reimbursement reduction in 2009, resulting in almost $24 less pay.

That's one thing experts discovered when the Centers for Medicare & Medicaid Services released its final version of next year's Physician Fee Schedule. A lower conversion factor, combined with a reduction of the relative value units (RVUs)

assigned to the technical component (TC) of certain diagnostic imaging procedures, will result in a national average reimbursement of only $216.40 (without geographical adjustments) for 92240 (Indocyanine-green angiography [includes multiframe

imaging] with interpretation and report) -- a 9.96 percent drop from 2008's $240.33.

Good news: But if your ophthalmologist only performs the professional component of 92240, you may see a small increase. The RVUs assigned to 92240-26 (Professional component) are staying put at 1.58 in 2009 -- and although the

conversion factor is slipping from 38.0870 to 36.0666, in 2009, CMS will no longer apply a budget neutrality adjuster (BNA) to a procedure's work RVUs. Result: A 92240-26 claim should bring in $56.99 in 2009, compared with $55.23 in 2008.

"There is a 6.5-percent, five-year practice expense reduction that has been in the works for the past five years, so without the 1.1 percent increase, we would be seeing a 6.5 percent overall decrease in reimbursement," says Barbara J. Cobuzzi,

MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions. "Instead, we are now seeing a 5.4 percent decrease."

Bad news: The loss in payment for the technical component of 92240 will more than offset the gain in the professional component. In 2009, 92240-TC only has 4.42 RVUs, compared with 4.86 in 2008. This brings the national payment for 92240-

TC down to $159.41 from last year's $185.10. Add $159.41 to the $56.99 payment for 92240-26 to arrive at the new global fee: $216.40.

Background: "The current five year review [of Medicare payments] focuses only on the physician work component of specific procedures," explains Maggie M. Mac, CMM, CPC, CPC-E/M, ICCE, consulting manager for Pershing, Yoakley, and

Associates in Clearwater, Fla. "However, future reviews will include the practice expense (technical component) when the resource-based values are established in the Medicare Fee Schedule. In other words, there are no work RVUs associated

with the technical component of a procedure."

The ongoing reduction in TC payments will also affect your reimbursements for A- and B-scans:

•76510 (Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter) ��" $147.15 in 2009 ($5.58 reduction from 2008)

•76511 (... quantitative A-scan only) -- $96.30 in 2009 ($11.11 reduction)

•76512 (... B-scan [with or without superimposed non-quantitative A-scan]) -- $90.53 in 2009 ($10.02 reduction)

•76516 (Ophthalmic biometry by ultrasound echography; A-scan) -- $66.72 in 2009 ($4.50 reduction)

•76519 (... with intraocular lens power calculation) -- $71.41 in 2009 ($4.00 reduction).

As with 92240, for each of these codes a small boost in the professional component RVUs is offset by a larger decrease in the technical component RVUs.

Example: In 2008, 76511-26 has 1.33 RVUs, and 76511-TC had 1.60 RVUs. In 2009, 76511-26 has 1.34 RVUs, but 76511-TC has dropped down to 1.33 RVUs. (See sidebar, page 2, for more information on Medicare payers' fee calculations in

2008 and 2009.)

While the RVUs for several procedures slip down, payment for most E/M codes, 99201-99215 (Office or other outpatient visit ...), creep up slightly. Your reimbursement for the most commonly- reported code, 99213, increased; whereas you

currently collect $59.80 for 99213 (not including geographic adjustment), you'll receive $61.31 for this service in 2009. And payments for 99214 will rise from the current amount of $89.89 to $92.33 next year.

The reimbursement for the eye exam codes also inches up in 2009. Expect $67.08 for an intermediate new-patient visit (92002, Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program;

intermediate new patient). For a comprehensive new-patient visit, 92004 (... comprehensive, new patient, 1 or more visits), you should see about $126.23. Anticipate $70.69 for an intermediate established-patient visit (92012, Ophthalmological

services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient) and $103.15 for a comprehensive established-patient visit (92014, comprehensive, established

patient, 1 or more visits). All of the 2009 amounts are a small increase (less than $2.00) from the 2008 amounts.

In 2009 your ophthalmologists are eligible to earn 2 percent of their total Medicare allowed charges if they adopt e-prescribing systems.

"E-prescribing can greatly reduce the number of medication errors that jeopardize the health and safety of Medicare patients and waste precious health care dollars treating conditions that never should have happened," said CMS Acting

Administrator Kerry Weems in a statement.

Take note: You do not have to have an electronic medical record (EMR) system to perform e-prescribing, says Cobuzzi. "There are many systems that are being made available that are stand-alone e-prescription systems that are substantially

less costly than a full-blown EMR." The ophthalmologist will have to register to be considered for the 2 percent bonus from e-prescribing, and then report e-prescription activity on 50 percent of the Medicare patients he sees.

Reporting requires the selection of one of three G codes which indicate one of three conditions: 1) that the physician used an e-prescription, 2) that the physician did not write a prescription, or 3) that the physician wrote or phoned in some or all

prescriptions due to patient request, to comply with state or federal law, because the pharmacy's system could not receive the data electronically, or because the prescription was for a narcotic or other controlled substance.

Online resources: To learn more about e-prescribing, visit http://www.cms.hhs.gov/eprescribing. To read CMS's final rule on payments for 2009, visit the Federal Register at http://edocket.access.gpo.gov/2008/pdf/E8-26213.pdf.

You can download a copy of the Physician Fee Schedule Relative Value File at www.cms.hhs.gov/PhysicianFeeSched.