Ophthalmology and Optometry Coding Alert

A quick glance at the proposed 2010 fee schedule shows increased relative value units (RVUs) for several ophthalmology procedures. Great news, right? Not so fast: Once you take the cuts to the conversion factor into account, the future's not so bright.

Example: In 2009, 66984 (Extracapsular cataract removal with insertion of intraocular lens prosthesis [1 stage procedure], manual or mechanical technique [e.g., irrigation and aspiration or  hacoemulsification]) has 17.71 total RVUs. In 2010, Medicare proposes to give the same procedure 19.33 RVUs. However, Medicare multiplies the RVUs by a conversion factor to arrive at the total reimbursement, and in 2010 the conversion factor may drop from $36.0666 to $28.4061. This will lead to a drop in reimbursement for 66984 from $638.74 (17.71 x $36.0666) to $549.09 (19.33 x $28.4061).

For more information on the conversion factor change, see "Fee Schedule Cuts Medicare Pay By 21.2%, Scraps Consults" on page 65. Read below to see how the proposed fee schedule changes will affect some of your common procedures starting next January.

Source: Table 50, "Impact of the Final Rule With Comment Period and Estimated Physician Update on 2010 Payment for Selected Procedures," from "Payment Policies Under the Physician Fee  Schedule and Other Revisions to Part B for CY 2010" at www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.