Q. What change occurred in the 2011 CPT manual in regards to scanning computerized ophthalmic diagnostic imaging (92135)?

A. The change eliminated CPT codes 92135 and 0187T and replaced them with three new codes:
  • 92132: Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral; 
  • 92133: Scanning computerized ophthalmic diagnostic imag-
ing, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve; and 
  • 92134: Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina. 
Although these codes are written as unilateral or bilateral, they are paid by Medicare as bilateral.

Note that a patient cannot have a SCODI done for glaucoma disease and retina disease at the same visit with claims filed for both tests. The CPT manual instructs, “Do not report 92133 and 92134 at the same patient encounter.” We also anticipate that Medicare’s NCCI edits will show these codes as mutually exclusive.

Q. What changes occurred with glaucoma surgery CPT codes? 
A. Several changes occurred for glaucoma surgery in the 2011 manual. Two new codes replace the Category III codes 0176T and 0177T. New Level One codes for canaloplasty are:
  • 66174: Transluminal dilation of aqueous outflow canal; without retention of device or stent; and 
  • 66175: Transluminal dilation of aqueous outflow canal; with retention of device or stent. 
  • A new Category III code was added and another was revised. Both address the location of aqueous drainage device placement. The new code and the revised code, respectively, are: 
  • 0253T: Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the suprachoroidal space; 
  • 0191T: Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the trabecular meshwork. 
Lastly, CPT code 66761 is revised to read: Iridotomy/iridectomy by laser surgery (e.g., for glaucoma) (per session). This code previously was a “one or more session” laser code with a 90-day postop period but is now considered by Medicare to be a minor procedure with a 10-day postop period.

Q. Were there any other changes regarding ophthalmology surgery?

A.Yes, several additions and changes were made to the codes describing amniotic tissue placement. Two new CPT codes exist for the use of amniotic membrane along with a series of additional instructions and a revision to the existing ocular surface reconstruction code. 
  • 65778: Placement of amniotic membrane on the ocular surface for wound healing; self-retaining; 
  • 65779: Single layer, sutured; and 
  • 65780: Ocular surface reconstruction; amniotic membrane transplantation, multiple layers. 
Additional instructions for the use of these codes exist in the CPT manual.

The New Technology Intraocular Lens reimbursement will also change. The Reduced Spherical Aberration category expires on February 26, 2011. Ambulatory surgery centers will no longer be filing with Q1003 receiving the additional $50 after the expiration date.

Q. What additional reimbursement changes occur for ASCs in 2011? 

A. 2011 begins the fully implemented reformed payment system for ASCs. The Consumer Price Index and the Multifactor Productivity Adjustment update the ASC conversion factor by 0.2 percent. The net effect of change from 2010 remains insignificant; however, Hospital Outpatient Department reimbursement rates for ophthalmic procedures have increased approximately 3 percent for 2011.

Q. What types of ophthalmic services are being scrutinized by the Office of Inspector General in 2011? 

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 during global surgery periods; E/M services; compliance with assignment rules; Modifiers GA/GZ/GY and appropriate use; and durable medical equipment claims submitted with modifiers.

New issues for scrutiny include error-prone providers  and payments for drugs, particularly Avastin and Lucentis.

Q. Are there any new claim filing instructions for Medicare claims? 

A. Yes. As of January 2010, Medicare claims must be filed within 12 months from the date of service. Some leeway exists if the patient fails to inform you that he switched from Medicare Advantage back to traditional Medicare.

Q. Is the Physician Quality Reporting Initiative continuing in 2011?
A. Yes. The more important points for the 2011 program include:
  • Name changed to “Physician Quality Reporting System;” 
  • Bonus reduced to 1 percent of total Medicare allowed dollars; 
  • An additional 0.5 percent may be earned for those participating in a Maintenance Certification Program; 
  • Seven of the eight ophthalmic measures applicable in 2010 remain in 2011; Measure 139, Cataract: Comprehensive preoperative assessment, is deleted; 
  • Two additional ophthalmic measures are only available if you report through a registry; and 
  • There are two reporting periods: January 1, 2011 through December 31, 2011 and July 1, 2011 through December 31, 2011. 
To receive this bonus, providers reporting on individual claims must successfully report at least 50 percent for each of three quality measures. This is a reduction from the 80-percent threshold that has been in place since 2007. 

This list is not exhaustive but highlights major changes for ophthalmology.

The PQRS program will be voluntary in 2011, however, the Affordable Care Act makes PQRS mandatory by 2015; nonparticipation will trigger a punitive -1.5 percent deduction from your Medicare reimbursement if not participating in 2015; -2 percent in 2016 and beyond.

Q. What changes take place with the E-prescribing bonus in 2011? 

A. Changes in the E-prescribing bonus are minimal. The bonus amount decreases to 1 percent. Successful participation requires submission of 25 electronic prescriptions. Physicians not participating in 2012 will see a 1-percent reduction in their Medicare reimbursement. CMS indicates that they will use data from the first six months of 2011 to determine who submits electronic prescriptions, who does not, and who to penalize in 2012.

Eligible professionals participating in the Health Information Technology bonus for electronic health records may not also apply for the E-prescribing bonus—they are mutually exclusive.

Unfortunately, CMS has not yet developed a system to track those physicians seeking the HIT bonus. In order to ensure that these physicians are not penalized for not participating in the E-Rx program, a minimum of 10 claims with the E-Rx code must be submitted between January and June 2011 for those seeking the HIT bonus.

Q. Are there any additional Part B costs for Medicare beneficiaries in 2011? 

A. The Medicare Part B premiums remain unchanged for 2011 for most beneficiaries. Part A deductible and inpatient copayments have increased a modest amount. The Part B deductible increases to $162.

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