2014 coding update

2014 CODING 2014 CODING UPDATEUPDATE

11

IncreasesIncreases

RVU RVU (Medcr)(Medcr)

EM office visits EM office visits (99xxx)(99xxx) +3%+3%

Ophthalmic office visitsOphthalmic office visits (92xxx)(92xxx) +6%+6%

Ext. Ophthal. Ext. Ophthal. (92225/6)(92225/6) +5% +5% ($28/$25)($28/$25)

Topography Topography (92025)(92025) +6% +6% ($38)($38)

Foreign Body, Conj. Foreign Body, Conj. (65205)(65205) +6% +6% ($58)($58)

Cornea puncture, tattoo Cornea puncture, tattoo (65600)(65600) +6% +6% ($411)($411)

Probe canaliculi Probe canaliculi (68840)(68840) +7% +7% ($135)($135)

22

DecreasesDecreases

RVU RVU (Medcr)(Medcr)

Fundus Photo Fundus Photo (92250)(92250) -6% -6% ($81)($81)

Cornea FB w/SL Cornea FB w/SL (65222)(65222) -7% -7% ($70)($70)

Fit CL for ocl. surface dx Fit CL for ocl. surface dx (92071)(92071) -10% -10% ($34)($34)

Cat. Sx. w/ IOL Cat. Sx. w/ IOL (66984-55)(66984-55) -12% -12% ($134)($134)

Photo, External Photo, External (92285)(92285) -14% -14% ($21)($21)

Visual Field, Extnd. Visual Field, Extnd. (92083)(92083) -26% -26% ($67)($67)

Photo, Specular Micrscpy Photo, Specular Micrscpy (92286)(92286) -69% -69% ($39)($39)

33

Amniotic MembraneAmniotic Membrane

65778 Placement of of amniotic 65778 Placement of of amniotic membrane on the ocular surface for membrane on the ocular surface for wound healing; self-retainingwound healing; self-retaining

Recurrent corneal erosion, Recurrent corneal erosion, infectious/inflammatory keratitis, infectious/inflammatory keratitis, herpes, superficial epithelial defects, herpes, superficial epithelial defects, severe dry eye, cornea disease. severe dry eye, cornea disease.

44


For healing persistent epithelial defects, For healing persistent epithelial defects, ulcers. When bandage CL needed, want ulcers. When bandage CL needed, want inflammation control, but cant use inflammation control, but cant use steroid.steroid.

$1469 $1469 (Medcr) (Medcr) Cost $800Cost $800

Paid by Medicare in several states.Paid by Medicare in several states.

55


Bio-Tissue PROKERA Bio-Tissue PROKERA www.biotissue.com www.biotissue.com

66

Scanning Laser for Scanning Laser for PlaquenilPlaquenil

V58.69 Long term (current) use of other V58.69 Long term (current) use of other medications; Other high-risk medicationsmedications; Other high-risk medications

Nine Medicare Part B contractors:Nine Medicare Part B contractors:

6 approve V58.69 (Novitas, CGS, First 6 approve V58.69 (Novitas, CGS, First Coast, NGS, NHIC, WPS). Three (Cahaba, Coast, NGS, NHIC, WPS). Three (Cahaba, Noridan, Palmetto) are silent about Noridan, Palmetto) are silent about V58.69 -- they have no LCD for OCT. V58.69 -- they have no LCD for OCT.

77

Scanning Laser for Scanning Laser for PlaquenilPlaquenil

States with Cahaba, Noridan, Palmetto: if States with Cahaba, Noridan, Palmetto: if 92134 with V58.69 is denied (as in the 92134 with V58.69 is denied (as in the past), submit an appeal, giving past), submit an appeal, giving evidence that Novitas, CGS, First evidence that Novitas, CGS, First Coast, NGS, NHIC, WPS pay for V58.69. Coast, NGS, NHIC, WPS pay for V58.69. Chances are good the contractor will Chances are good the contractor will reverse its decision and it will be paid.reverse its decision and it will be paid.

88

Medicare Medicare

MEDICARE PAYMENT REDUCTION MEDICARE PAYMENT REDUCTION PROGRAMS: PROGRAMS:

OPPS, MPPR, SEQUESTRATIONOPPS, MPPR, SEQUESTRATION

99

Medicare Medicare

OPPS - Medicare put payment cap on OPPS - Medicare put payment cap on some diagnostic imaging services, some diagnostic imaging services, based on fee caps of Hospital based on fee caps of Hospital Outpatient Prospective Payment Outpatient Prospective Payment System (OPPS). System (OPPS).

The only optometric code affected is The only optometric code affected is 92250 Fundus Photography. 92250 Fundus Photography.

1010

Medicare Medicare

MPPR - Medicare reduces payment on MPPR - Medicare reduces payment on some diagnostic ophthalmology some diagnostic ophthalmology procedures, when two (or more) are procedures, when two (or more) are billed on the same day. billed on the same day.

The MPPR (Multiple Procedure Payment The MPPR (Multiple Procedure Payment Reduction) reduces payment on the Reduction) reduces payment on the 2nd code (and the 3rd, 4th, etc).2nd code (and the 3rd, 4th, etc).

1111

Medicare Medicare

MPPR – MPPR –

The first diagnostic procedure is paid at The first diagnostic procedure is paid at the normal rate. The first diagnostic the normal rate. The first diagnostic procedure is defined as the one with procedure is defined as the one with highest value.highest value.

1212

Medicare Medicare

MPPR – MPPR – 7651476514 PachymetryPachymetry

9202592025 Corneal topography Corneal topography

9206092060 Sensorimotor examSensorimotor exam

9208392083 Visual field, extendedVisual field, extended

9213292132 Scanning imaging, anterior segmentScanning imaging, anterior segment

9213392133 Scanning imaging, optic nerve Scanning imaging, optic nerve

9213492134 Scanning imaging, retina Scanning imaging, retina

1313

Medicare Medicare

MPPR – MPPR – 9225092250 Photo, fundusPhoto, fundus

9228592285 Photo, externalPhoto, external

9228692286 Photo, specular endothelial microscopy Photo, specular endothelial microscopy

file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-file://localhost/Users/alanhomestead/Documents/My Documents B 3-8-13/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 Files XLSX/1 13/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee 2013 15.4.xlsxAccuFee 2013 15.4.xlsx

1414

Medicare Medicare

SEQUESTRATION - Federal budget problems SEQUESTRATION - Federal budget problems resulted in an overall 2% reduction of resulted in an overall 2% reduction of physician pay. physician pay.

Medicare pays the physician 78% of the Medicare pays the physician 78% of the allowed payment, and the patient still owes allowed payment, and the patient still owes 20% of the Allowed Payment. 20% of the Allowed Payment.

Allowed Payment remains the same.Allowed Payment remains the same.file://localhost/Users/alanhomestead/Documents/My Documents file://localhost/Users/alanhomestead/Documents/My Documents

B 3-8-13/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 B 3-8-13/Adventures 11-3-12/1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee 2013 15.4.xlsxFiles XLSX/1 AccuFee 2013 15.4.xlsx

1515

GLAUCOMA STAGE ICD GLAUCOMA STAGE ICD CODESCODES

1616

Using Glaucoma Stage Using Glaucoma Stage CodeCode

Select ICD code for type of glaucoma Select ICD code for type of glaucoma (same as past) from 38 glaucoma (same as past) from 38 glaucoma codes (365.xx)codes (365.xx)

1717

If selected code is one of 11 (below), add If selected code is one of 11 (below), add Glaucoma Stage code in 2nd position on Glaucoma Stage code in 2nd position on claim formclaim form

365.10 Open-angle glaucoma, unspecified365.10 Open-angle glaucoma, unspecified

365.11 Primary open angle glaucoma365.11 Primary open angle glaucoma

365.12 Low tension glaucoma365.12 Low tension glaucoma

365.13 Pigmentary glaucoma365.13 Pigmentary glaucoma

365.20 Primary angle-closure glaucoma, 365.20 Primary angle-closure glaucoma, unspecifiedunspecified

1818

365.23 Chronic angle-closure glaucoma365.23 Chronic angle-closure glaucoma

365.31 Corticosteroid-induced glaucoma, 365.31 Corticosteroid-induced glaucoma, glaucomatous stageglaucomatous stage

365.52 Pseudoexfoliation glaucoma365.52 Pseudoexfoliation glaucoma

365.62 Glaucoma associated with ocular 365.62 Glaucoma associated with ocular inflammationsinflammations

365.63 Glaucoma associated with vascular 365.63 Glaucoma associated with vascular disordersdisorders

365.65 Glaucoma associated with ocular trauma365.65 Glaucoma associated with ocular trauma

1919

Select Glaucoma Stage code Select Glaucoma Stage code (physicians (physicians judgment)judgment)

365.70 Glaucoma stage, unspecified365.70 Glaucoma stage, unspecified No documentation regarding stage of glaucomaNo documentation regarding stage of glaucoma

365.71 Mild stage glaucoma365.71 Mild stage glaucoma Optic nerve changes consistent with glaucomaOptic nerve changes consistent with glaucoma

No VF loss on white-on-white perimetryNo VF loss on white-on-white perimetry

VF loss may be on short-wavelength automated perimetry VF loss may be on short-wavelength automated perimetry or frequency-doubling perimetryor frequency-doubling perimetry

2020

365.72 Moderate stage glaucoma365.72 Moderate stage glaucoma Optic nerve changes consistent with glaucomaOptic nerve changes consistent with glaucoma

VF loss in one hemifield VF loss in one hemifield

Not within 5° of fixationNot within 5° of fixation

365.73 Severe stage glaucoma365.73 Severe stage glaucoma Optic nerve change consistent with glaucomaOptic nerve change consistent with glaucoma

VF loss in both hemifields VF loss in both hemifields

VF loss within 5° of fixation in at least one hemifieldVF loss within 5° of fixation in at least one hemifield

2121

365.74 Indeterminate stage glaucoma365.74 Indeterminate stage glaucoma

Glaucoma stage cannot be determinedGlaucoma stage cannot be determined

Had no time to do VFHad no time to do VF

Patient canPatient can’’t do VF t do VF

VF unreliable or uninterpretable, so stage of glaucoma is VF unreliable or uninterpretable, so stage of glaucoma is unsureunsure

Do not confuse 365.74 with 365.70 which is no Do not confuse 365.74 with 365.70 which is no documentation regarding stage of glaucomadocumentation regarding stage of glaucoma

2222

Bilateral GlaucomaBilateral Glaucoma

Same type and stageSame type and stage Report one code for type of glaucoma, and one Glaucoma Report one code for type of glaucoma, and one Glaucoma

stage codestage code

Same type but different stageSame type but different stage Report one code for type of glaucoma, and one Glaucoma Report one code for type of glaucoma, and one Glaucoma

stage code for the highest glaucoma stagestage code for the highest glaucoma stage

Each eye different type and different stageEach eye different type and different stage Report two codes, one for each type glaucoma, and one Report two codes, one for each type glaucoma, and one

Glaucoma stage code for highest glaucoma stageGlaucoma stage code for highest glaucoma stage

2323

Claim FormClaim Form

Enter stage code adjacent to glaucoma Enter stage code adjacent to glaucoma diagnosisdiagnosis

Report with office visit code and every Report with office visit code and every related procedure done during visitrelated procedure done during visit

2424

Secondary CodesSecondary Codes

Glaucoma stage codes are secondary add-Glaucoma stage codes are secondary add-on codeson codes

Glaucoma stage codes are not principal or Glaucoma stage codes are not principal or first-listed or primary diagnosis codesfirst-listed or primary diagnosis codes

2525

HIPAAHIPAA

Adherence to ICD guidelines is required by Adherence to ICD guidelines is required by HIPAAHIPAA

HIPAA applies to anything transmitted HIPAA applies to anything transmitted electronicallyelectronically

Some plans may be slow to recognize new Some plans may be slow to recognize new codescodes

2626

PAYMENT IF NOT PAYMENT IF NOT REPORTED?REPORTED?

Florida MAC says YesFlorida MAC says Yes

Noridian?Noridian?

WPS?WPS?

Non-Medicare?Non-Medicare?

2727

INFORMATIONINFORMATION

Teaching tool by AGS Teaching tool by AGS

http://www.americanglaucomasociety.net/http://www.americanglaucomasociety.net/professionals/professionals/glaucoma_staging_codes_teaching_module/glaucoma_staging_codes_teaching_module/

Google Google ““American Glaucoma SocietyAmerican Glaucoma Society””

2828

CPT CODESCPT CODES

Deleted 2012 Deleted 2012

92070 92070

Fitting of contact lens for treatment of Fitting of contact lens for treatment of disease, including supply of lens disease, including supply of lens

2929

CPT CODESCPT CODES

New 2012 New 2012

92071 92071

Fitting of contact lens for treatment of Fitting of contact lens for treatment of ocular surface disease ocular surface disease

Report supply of lens separately with 99070 or V Report supply of lens separately with 99070 or V codecode

3030

CPT CODESCPT CODES

New 2012 New 2012

92072 92072

Fitting of contact lens for management of Fitting of contact lens for management of keratoconus , initial fitting keratoconus , initial fitting

Report supply of lens separately with 99070 or V Report supply of lens separately with 99070 or V codecode

Subsequent fittings, report 99 or 92 office call codeSubsequent fittings, report 99 or 92 office call code

3131

Remote ImagingRemote Imaging

New in 2011New in 2011

Remote imaging for Remote imaging for detectiondetection of retinal of retinal disease disease

andand

Remote imaging for Remote imaging for monitoring and monitoring and management of activemanagement of active retinal disease retinal disease

3232



9222792227 Remote imaging for detection of Remote imaging for detection of retinal disease (eg, retinopathy in a retinal disease (eg, retinopathy in a patient with diabetes) with analysis and patient with diabetes) with analysis and report under physician supervision, report under physician supervision,

unilateral or bilateral.unilateral or bilateral.

3333


9222792227

This code has no physician work and is This code has no physician work and is intended for use by non-physician readersintended for use by non-physician readers

For detection or screening for retinopathyFor detection or screening for retinopathy

Used when it is unknown if patient has Used when it is unknown if patient has retina disease - just looking for itretina disease - just looking for it

3434



92228 92228 Remote imaging for monitoring and Remote imaging for monitoring and management of management of activeactive retinal disease (eg, retinal disease (eg, diabetic retinopathy) with physician diabetic retinopathy) with physician review, interpretation and report, review, interpretation and report,

unilateral or bilateral. unilateral or bilateral.

3535


9222892228

When patient has active retinopathy being When patient has active retinopathy being managedmanaged

For For physiciansphysicians involved with remote involved with remote imagingimaging

3636


9222892228 exampleexample

Separate entity (eg Separate entity (eg reading center)reading center) owns owns imaging systemimaging system

It is placed in PCP officeIt is placed in PCP office

PCP staff takes imagePCP staff takes image

3737



Image is sent to OD/OMD for I&RImage is sent to OD/OMD for I&Roror

Reading center staff provides I&R, under Reading center staff provides I&R, under physician supervisionphysician supervision

PCP bills w/ TC, PCP bills w/ TC,

OD/OMD/Reading center bills w/ 26OD/OMD/Reading center bills w/ 26

3838



92228-26 $21.43 92228-26 $21.43 (Medicare 2013)(Medicare 2013)

3939

Deleted CPTDeleted CPT

9212092120 Tonography; recording indentation Tonography; recording indentation tonometer or perilimbal suction tonometer or perilimbal suction

9213092130 Water provocation tonography Water provocation tonography

4040

ICD-10ICD-10

ICD-10-CMICD-10-CM

October 1, 2014 implementationOctober 1, 2014 implementation

4141

ICD-10ICD-10

ICD-10-CM ICD-10-CM “Benefits”“Benefits” Measure quality, safety, efficacy of careMeasure quality, safety, efficacy of care Reduce need for attachments to explain pt’s conditionReduce need for attachments to explain pt’s condition Design payment systems & process claims for paymentDesign payment systems & process claims for payment Conduct research, epidemiological studies, clinical trialsConduct research, epidemiological studies, clinical trials Setting health policy Setting health policy Operational and strategic planningOperational and strategic planning Designing health care delivery systemsDesigning health care delivery systems Monitor resource useMonitor resource use Improve clinical, financial, administrative performance Improve clinical, financial, administrative performance Prevent and detect health care fraud and abusePrevent and detect health care fraud and abuse Track public health and risksTrack public health and risks

4242

TearLab Osmolarity TestTearLab Osmolarity Test

Waived Test ApprovalWaived Test Approval

Effective January 1, 2012Effective January 1, 2012

CMS pays 83861 in each state $23.25 per CMS pays 83861 in each state $23.25 per eyeeye

4343

DMEPOSDMEPOS

FeeFee

January 1, 2013 application fee for CMS January 1, 2013 application fee for CMS 855S for enrollment or revalidation with 855S for enrollment or revalidation with DME is $523DME is $523

Fee will remain $532 until December 31, Fee will remain $532 until December 31, 20132013

(was $505, $523)(was $505, $523)

4444

DMEPOSDMEPOS

Durable Medical Equipment, Prosthetics, Durable Medical Equipment, Prosthetics, Orthotics, and SuppliesOrthotics, and Supplies

Can you sell post cataract glasses if not a Can you sell post cataract glasses if not a provider?provider?

4545

Medicare CFMedicare CF

Conversion FactorConversion Factor

34.02334.023

January 1, 2013 to December 31, 2013January 1, 2013 to December 31, 2013

4646

Medicare ABNMedicare ABN

Advanced Beneficiary NoticeAdvanced Beneficiary Notice

ABN Form CMC-R-131 (03/11)ABN Form CMC-R-131 (03/11)

Only acceptable version after January 1, Only acceptable version after January 1, 20122012

4747

LCDLCD

file://localhost/Users/alanhomestead/file://localhost/Users/alanhomestead/Documents/My Documents B Documents/My Documents B 3-8-13/Adventures 11-3-12/O - 3-8-13/Adventures 11-3-12/O - S/Presentations/Repository of My S/Presentations/Repository of My PowerPoints/1 Topic Modules/LCD/LCD PowerPoints/1 Topic Modules/LCD/LCD Aug 13.pptxAug 13.pptx

4848