Ophthalmology and Optometry Coding Alert

Question: I'm very confused about what Medicare will pay for ophthalmology physician services starting Jan. 1. Has Congress finally settled on a payment rate for 2010?

Illinois Subscriber

Answer: Yes and no. Congress has delayed the expected decrease to the conversion factor until March 1, so you can expect fairly constant payment until that time. You'll see changes based on adjusted relative value units (RVUs) for a specific code, not based on the expected large conversion factor reduction -- at least for now.

With just days to go until the government slashed the conversion factor by 21.2 percent, Congress stepped in. On Dec. 16, the House of Representatives voted to approve an amendment to HR 3326 (the Dept. of Defense Appropriations Act) that would freeze Medicare payments at current levels through the end of February. The Senate followed suit on Dec. 18 and approved the bill as well. This temporary fix is being considered as a "bridge" to help physician payments stay stable while a more permanent fix is still up in the air, as Congress hasn't made a decision on whether to permanently change the sustainable growth rate formula.

President Obama signed the temporary pay fix into law on Dec. 19. CMS subsequently issued MLN Matters article MM6796, which announced that due to RVU adjustments, the conversion factor during the two-month temporary pay fix period would not remain at the 2009 level of $36.0666, but would instead rise two cents to $36.0846.

Plus: To give MACs time to adjust their fee schedules and claims systems based on the new conversion factor boost, CMS has instructed its contractors to hold Medicare claims for 2010 dates of service "for the first 10 business days of January (January 1 through January 15)," according to a Dec. 21 CMS listserv notification.

-- Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, director, Best Practices-Network Operations at Mount Sinai Hospital in New York City.