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Ophthalmology and Optometry Coding Alert

Finalized 2003 Fee Schedule Confirms Ophthalmologists Fears

Published on Sat Feb 01, 2003

Finally, the Centers for Medicare and Medicaid Services has published the 2003 Physician Fee Schedule and reimbursement looks pretty bleak for ophthalmologists.

The 2003 fee schedule update, published in the Dec. 31, 2002, Federal Register, indicates a 4.4 percent cut in payment for all reported codes, a result of the decrease in the conversion factor from $36.1992 in 2002 to $34.5920 in 2003, which goes into effect March 1, 2003.

But some ophthalmologists remain optimistic that there is enough time for Congress to implement a fix and Michael J. Yaros, MD, a practicing ophthalmologist based in Runnemede, N.J., is one of them. He contemplates whether "having a physician as the majority leader of the Senate" will prompt the fix.

Commenting on the literature suggesting that physicians may curtail their Medicare services, Yaros concedes that "new patients may not be accepted, and participation rates may drop ... but it would be hard to give up Medicare and survive." Yaros believes the real problem is that many health plans base reimbursement on Medicare and sometimes they pay even less than Medicare. "The combination of higher malpractice and lower reimbursements will likely spur many ophthalmologists to consider early retirement and discourage purchases and updates of equipment."

Although ophthalmologists can expect, as of now, to see fee reductions anywhere and everywhere from routine new patient eye exams i.e., 92004, which pays 6 percent less in 2003 than 2002 to a facility-rendered retina repair 67108, whose fee decreased $85.30 this year the American Academy of Ophthalmology did manage successfully to advocate the correction of some ophthalmology service anomalies:

  • For CPT code 67820* (Correction of trichiasis; epilation, by forceps only) CMS proposed to remove ophthane from the supply list
  • For CPT code 67825* ( epilation by other than forceps [e.g., by electrosurgery, cryotherapy, laser surgery]) CMS proposed to remove the bipolar handpiece from the supply list
  • For CPT code 65220* (Removal of foreign body, external eye; corneal, without slit lamp) CMS proposed using the supply list and clinical staff time assigned to CPTcode 65222* ( corneal, with slit lamp) and clarified that "the exam lane is the only equipment assigned"
  • For visual-field examination CPT codes 92081 and 92083, CMS proposed to assign the same supplies and equipment as visual-field examination CPT code 92082 and to assign 35 minutes of clinical staff time to 92081 and 70 minutes to 92083.

    Yaros considers the changes to the visual-field codes directly attributable to CPTcode 92081's fee being too high relative to 92083. "Most practices do use the same supplies and machines for all three VF codes," he says.

    According to the Federal Register report, commenters were supportive of the proposed revisions, and CMS will be finalizing the revisions as proposed.

    Among many other modifications, the Fee Schedule contains revisions to the sustainable growth rate, 7.6 percent in 2003, clarification of CMS'policy regarding incident-to services and supplies, finalization of both the 2002 interim relative value units (RVUs), and issuance of interim RVUs for new and revised codes for 2003.

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