Q What Category I code changes were published with the 2013 Current Procedural Terminology manual?

A Several changes appear in the CPT 2013 manual, including new, revised and deleted codes. The new code is 64615 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, trigeminal, cervical spinal and accessory nerves, bilateral (e.g., for chronic migraine). Report 64615 only once per session, and do not report 64615 in conjunction with 64612, 64613 or 64614.

The revised codes, with revisions underlined, are:

64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (e.g., for blepharospasm, hemifacial spasm). (To report a bilateral procedure, use modifier 50);
65800 Paracentesis of anterior chamber of eye (separate procedure), removal of aqueous;
67810 Incisional biopsy of eyelid skin including lid margin;
99174 Instrument-based ocular screening (e.g., photoscreening, automated refraction), bilateral

The deleted code is 65805, with therapeutic release of aqueous.

Q Were there any Category III code changes published in the CPT 2013 manual?

A Yes, there was one new Category III ophthalmology code implemented on July 1, 2012 and printed in the CPT 2013 manual: 0308T Insertion of ocular telescope prosthesis including removal of crystalline lens. Do not report 0308T in conjunction with 65800-65815, 66020, 66030, 66600-66635, 66761, 66825, 66982-66986 or 69990.

Additionally, the following Category III code was deleted in 2013: 0173T Monitoring of intraocular pressure during vitrectomy surgery.
Coverage and payment for Category III codes remains at carrier discretion. 

Q Were there changes made to the relative value units of some ophthalmic codes in the 2013 CPT manual?

A Yes, a series of ophthalmic services were included in a review by the Relative Value Scale Update Committee. The following codes are examples of those reduced in their relative value units and the percentage of change from 2012:

Fluorescein angiogram (92235)—6 percent;
IV injections (67028)—9 percent;
Cataract surgery w/IOL  (66984)—12 percent;
Complex cataract surgery w/IOL (66982)—25 percent;
Visual field (92083)—29 percent;
Endothelial cell count (92286)—70 percent.

Q Are there new drug codes pertinent to ophthalmology in the 2013 Healthcare Common Procedural Coding System manual? 
A Yes, the 2013 HCPCS manual contains the following new codes: J7315—Mitomycin, ophthalmic, 0.2 mg and J0178—Injection, aflibercept, 1 mg. The J0178 code replaces the temporary code of Q2046 and will require two units on the claim form for appropriate reimbursement of the drug vial.

Q Were there any changes to diagnosis codes that require attention? 

A No new ICD-9 codes were published in the fall of 2012. This is due to anticipated implementation of ICD-10, which has been delayed until October 1, 2014.  

Q What is the new Multiple Procedure Payment Reduction (MPPR) policy that went into effect in January?

A The MPPR policy reduces the technical component of the second and subsequent diagnostic tests by 20 percent when more than one diagnostic test is performed at one patient encounter on the same day by the same physician or group. The list of tests includes ultrasounds, imaging and visual fields. Tests that do not have a technical component (i.e., gonioscopy) are not subject to this policy.

Q Did ambulatory surgery centers and hospital outpatient department rates realize an increase to facility fees in 2013? 

A For 2013, the Consumer Price Index and Multifactor Productivity Adjustment have updated the ASC conversion factor by 0.6 percent. HOPD rates increased approximately 1.8 percent for 2013. 

Q What types of regulatory issues were identified as areas of concern for ophthalmology in 2013?

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; Use of Modifiers During Global Surgery Periods; E/M Services Inappropriate Payments in 2010; Error-Prone Providers; Payments for drugs; Incident-To Services; Ambulatory Surgical Centers–Payment System; and Incentive Payments for Electronic Health Records.

New issues for scrutiny include: Ophthalmological Services–Questionable Billing; Modifiers GA/GZ/GY and appropriate use; Onsite Visits for Medicare Provider and Supplier Enrollment and Reenrollment; Hospitals–Acquisitions of Ambulatory Surgical Centers; and Impact on Medicare Spending.

Q Is the OIG still concerned about electronic health record documentation practices?

A Yes. The OIG says that it will continue to “review multiple E/M services for the same providers and beneficiaries to identify electronic health records documentation practices associated with potentially improper payments.

Q When must professionals begin to utilize electronic health records to avoid penalties?

A Professionals must start using electronic health records in a “meaningful” way by July 1, 2014, and complete their meaningful use attestation for Stage One by October 1, 2014, in order to avoid penalties in 2015. (For more information, see “The Fundamentals of Meaningful Use” in the October 2012 issue of the Review.)

Q Is the Recovery Audit Contractor Program continuing to report successful recoupment of overpaid dollars, and will it continue to expand?

A Yes. The RAC program reported $1.8 billion in corrections with $1.6 billion collected in overpayments and $130 million returned to providers for underpayments for FY 2012 (11 months). The total corrections since 2010 are $2.8 billion.  

The RAC program has already expanded to include Medicare C plans and individual states are contracting with RACs to audit the Medicaid program.  

Q What Medicare Part B changes affect beneficiaries in 2013 from a cost perspective?

A The Medicare Part B premiums increased in 2013 to $104.90 for most beneficiaries. The Part B deductible increased from $140 to $147. 

Q Is participation in the Physician Quality Reporting System mandatory in 2013? Is there any bonus for participation?

A The program is not mandatory until 2015; however, CMS will utilize the reporting data in 2013 to determine who will be penalized with a 1.5 percent payment adjustment in 2015. The PQRS bonus remains at 0.5 percent of total Medicare allowed dollars to those who successfully participate in the program.

Q Are there changes to the electronic prescribing program for 2013?  

A There are minimal changes. The bonus amount reduces to 0.5 percent, and some providers will be penalized for not meeting the participation requirement or qualifying for an exemption. The 2013 penalty is 1.5 percent on Medicare Part B allowed charges.  REVIEW

Ms. McCune is vice president of the Corcoran Consulting Group. Contact her at DMcCune@corcoranccg.com.