A. CPT code 92070, Fitting of contact lens for treatment of disease, including supply of lens, has been deleted and replaced by two new codes. They are: 

The CPT manual specifies that you should not report 92071 in conjunction with 92072 (or 92072 in conjunction with 92071) and that you should report a supply of lenses separately with 99070 or the appropriate supply code.

A. Additional deleted codes include two diagnostic tests:

A. Yes. New Category III codes implemented on July 1, 2011 appear in the hardcopy CPT 2012. The “+” indicates “add-on” codes. These codes are added to the primary procedure:

These add-on codes are to be used in conjunction with codes 65710, 65730, 65750 or 65755. Coverage and payment for Category III codes remains at carrier discretion.

A. Yes. The 2012 HCPCS manual contains the following new codes:

A. ASC payment reform is complete. The Consumer Price Index and Multifactor Productivity Adjustment updates the ASC conversion factor by 1.6 percent, which results in a positive change to facility reimbursement. 

A. Yes. ASCs continue to focus on compliance with the revised CFC, in place since May 2009. The Centers for Medicare & Medicaid published a revision to the timing of patient rights notification. The original regulation required greater than 24 hours notice of patient rights before each surgery, unless the surgery was an emergency. CMS recognized that many physicians perform same-day surgery for non-emergent conditions and have revised the regulation to allow for same-day notification of rights, effective December 23, 2011.

A. HOPD rates increased approximately 2 percent for 2012, with some minor changes to ophthalmic procedure facility reimbursement.

A. The annual publication of the Office of Inspector General Work Plan identifies a series of items applicable to ophthalmology. Returning issues include: place-of-service errors; E/M services; E/M services during global surgery periods; modifiers GA/GZ/GY; durable medical equipment claims submitted with modifiers; enrollment and monitoring of DME suppliers; error-prone providers; and payments for drugs.

New issues for scrutiny include: incident-to services; impact of opting out of Medicare; use of modifiers during global surgery period; and incentive payments for electronic health records.

This list is not exhaustive but provides insight into targets applicable to ophthalmology.

A. Yes. The OIG’s interests include possible inappropriate payments for E/M services documented in EHRs. The 2012 work plan states, “We will also review multiple E/M services for the same providers and beneficiaries to identify electronic health records (EHR) documentation practices associated with potentially improper payments. Medicare contractors have noted an increased frequency of medical records with identical documentation across services.”¹

The technique known as “carry forward” creates the potential for inaccurate record keeping and increased criticism of the integrity of the medical record. Based on the OIG’s work plan, Medicare contractors have the same concern: Office notes that contain the exact same documentation create doubt as to the authenticity of the notes. Caution with this technique is merited.

A. Yes. While the ophthalmic measures applicable in 2011 remain, the bonus has been reduced to 0.5 percent of total Medicare allowed dollars.

Two new measures were added but are only available if you report through a registry: 

CMS no longer permits a six-month reporting option for claims and registry reporting of individual measures. It permits a six-month reporting (July 1 to December 31) of measure groups reported by a registry.

A new Cataract Measure Group was approved for 2012; it must be reported through a registry and includes the following:

CMS is finalizing criteria for reporting via EHR.

A. Yes; it becomes mandatory in 2015. However, CMS will utilize the reporting data in 2013 to determine who will be penalized with a 1.5 percent negative payment adjustment in 2015.  In order to avoid this penalty, physicians need to participate in 2013.

A. Changes in the eRx bonus are minimal. The bonus amount remains at 1 percent. Some providers will be penalized for not meeting the participation requirement or qualifying for an exemption. The 2012 penalty is -1 percent on Medicare Part B allowed charges. The success threshold for 2012 requires successfully reporting 25 electronic prescriptions.

A. Yes. Eligible providers should report 10 eRxs in the first six months of 2012 for purposes of 2013 and 2014 payment adjustment determination.

Hardship exemptions do exist to negate 2013 and 2014 payment penalties:

No bonus payments or payment reductions have been authorized beyond 2014 for the eRx program. Eligible professionals participating in the health information technology bonus for EHRs may not apply for the eRx bonus; they are mutually exclusive.

A. Yes. The Medicare Part B premiums increased to $99.90 for most beneficiaries; however, the Part B deductible decreased to $140.   REVIEW