Ophthalmology and Optometry Coding Alert

Everything changes starting next January--will you be ready?

Good news: Your payments for evaluation and  management services could rise dramatically next year.

The Centers for Medicare & Medicaid Services published a proposed regulation in the June 29 Federal Register that would transform your reimbursement in two fundamental ways:

1. What the reg means for work RVUs. The work relative value units (RVUs) for E/M services would increase, thanks to proposals from the Relative Value Update Committee (RUC).

The work RVUs for a level-three established patient office visit (99213, Office or other outpatient visit for the evaluation and management of an established patient ...) would rise by a startling 37 percent.
 
Work RVUs for level-four office visits (99204 for new patients and 99214 for established patients) would increase by 29 percent.

The work RVUs for more than 400 other services will also change to reflect more accurately the time and work your physician spends on them. CMS says it spends $35 billion on work RVUs, or more than half of all physician payments.

Expect Boost in YAG Pay

Proposed changes in work RVUs for ophthalmology codes include:

• 66761 (Iridotomy/iridectomy by laser surgery [e.g., for glaucoma] [one or more sessions]): work RVUs increasing from 4.06 to 4.81

• 66821 (Discission of secondary membranous cataract [opacified posterior lens capsule and/or anterior hyaloid]; laser surgery [e.g., YAG laser] [one or more stages]): work RVUs increasing from 2.35 to 2.78

• 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis ...): work RVUs decreasing from 10.21 to 9.78

• 67820 (Correction of trichiasis; epilation, by forceps only): work RVUs decreasing from 0.89 to 0.71

• 67904 (Repair of blepharoptosis; [tarso] levator resection or advancement, external approach): work RVUs increasing from 6.25 to 7.75

2. What the reg means for PE-RVUs. CMS plans to change how it calculates practice expense RVUs (PE-RVUs). CMS would apply a "bottom up" method using data about how much it costs to do each individual procedure.

It would calculate indirect expenses differently and use survey data from allergists/immunologists, cardiologists, dermatologists, gastroenterologists, radiologists, radiation oncologists, urologists and independent diagnostic testing facilities.

And CMS would scrap the nonphysician work pool, paying for codes with no physician work using its regular practice expense methodology.

This PE-RVU transition would happen over the next four years. CMS spends $30 billion on PE-RVUs, or about  45 percent of physician payments.

Let CMS Know What You Think

Speak up: CMS is seeking comment on both proposals until Aug. 21. The agency plans to finalize the proposals in November as part of the same final rule that tackles other changes to next year's physician fee schedule.
 
For more information on commenting, visit the CMS site www.cms.hhs.gov/eRulemaking.

Relief Is on the Way

Providers had expected CMS to boost work RVUs for E/M visits by slashing work RVUs for procedures because procedures have grown, claiming a bigger and bigger share of the RVU pie over the past few years.

Instead, CMS aims to spend an extra $4 billion on Medicare, tossing out its usual rules requiring "budget neutral" spending.

CMS will use a "budget neutrality adjuster" for work RVUs, which gives it some wiggle room.

To see all the proposed changes, go to the CMS site  www.cms.hhs.gov/PhysicianFeeSched, click "PFS Federal Regulation Notices" and select "CMS-1512-PN."