Ophthalmology and Optometry Coding Alert

Tip: PQRI continues for next year, so get busy planning now

Take note of several changes CMS hopes to make for 2008 to ensure you won't be blindsided if they take effect. Watch for these five changes that CMS explains in its proposed plans for next year that were released on July 12:

- Quality: CMS unveils new quality measures in seven different categories that it wants to include in next year's Physician Quality Reporting Initiative (PQRI). The measures must win the approval of the National Quality Forum (NQF) or the AQA Alliance (AQA) to make it into the PQRI.

The proposed new measures come from the AQA Starter Set, the NQF Ambulatory measure set, and some new measures being developed with the AMA. Medicare will continue to pay bonuses of 1.5-2.0 percent for reporting on quality indicators into 2008.

The measures include ones relating to optic nerve evaluation for primary open-angle glaucoma; documentation of the presence or absence of macular edema and the disease's severity level for those with diabetic retinopathy; communication with the physician managing ongoing care for those with diabetic retinopathy; and a fourth, unspecified measure on age-related macular degeneration.

- Geographic index: CMS also updated its geographic index of physician practice costs to reflect newer data. This may not, however, protect Medicare from a recent lawsuit by California counties that have lost out on physician reimbursement because of inaccurate data showing them as low-cost areas.

- Imaging: Medicare would still cap the technical component of imaging procedures at the hospital outpatient rate. And it would apply that cap to some ophthalmologic imaging services.

- Compliance: The rule would close some loopholes in the physician self-referral rules that CMS says have made the program -vulnerable to abuse.- In particular, you can't mark up the cost of a diagnostic test that your practice purchased from another group or physician.

- E-prescribing: Computer-generated faxes would have to comply with normal standards for electronic prescriptions. Letting your computer create a fax was supposed to serve as training wheels for real electronic prescriptions, but now CMS is worried that doctors and pharmacies haven't moved beyond the fax yet.

For more information about CMS- proposals, go to www.cms.hhs.gov/center/physician.asp.