Ask the Coding Experts, by Doug Morrow, O.D., Harvey Richman, O.D., Rebecca Wartman, O.D. From the September 2016 edition of AOA Focus, page 50-51.
With the Merit-Based Incentive Payment System (MIPS) scheduled to begin in 2017, there are many changes coming down the pike that will impact doctors of optometry.
In addition to this significant shift in Medicare payment structure, there are many coding-related changes that doctors will need to be aware of in 2017 and beyond.
Some of the most significant code changes are related to 2017 changes in ICD-10 codes. Leading up to the implementation of ICD-10, there was a partial code freeze in place. That code freeze has now been lifted, and hundreds of new ICD-10 code additions, changes and deletions will take place on Oct. 1, 2016.
Developing values for CPT codes: Your feedback is critical
Over the past several years, the Centers for Medicare & Medicaid Services (CMS) has grappled with how to appropriately value codes with global periods. CMS is concerned that post-surgical visits are valued higher than visits that were furnished and billed separately. In 2014, CMS attempted to do away with global periods entirely, but Congress intervened, which disallowed CMS to move forward with this elimination.
Instead, Congress required CMS to develop a process to gather information needed to value surgical services from a representative sample of physicians. Statute requires that the collected information include the number and level of medical visits furnished and other items and services related to the surgery and furnished during the global period. During the summer of 2016, CMS released its initial proposal for gathering this information.
This may require doctors to add an additional G code on claims when services are provided as part of a global services package. This could be a significant burden on doctors, and AOA will be providing additional direction and guidance if CMS moves forward with this process for obtaining this data.
AOA remains fully engaged in the Current Procedural Terminology (CPT) code development and refinement process and the Relative Value Scale Update Committee (RUC) process, which is used to develop values for CPT codes. In order to develop values for CPT codes, surveys are used to gather data. Physicians who perform a particular service are surveyed to obtain information on the work involved in the new or revised code. When codes that doctors of optometry report are under review, the AOA conducts the survey, reviews the results and prepares recommendations to the RUC.
In 2016, AOA has surveyed for three CPT codes: 95930 (visual evoked potential testing central nervous system except glaucoma, checkerboard or flash, with interpretation and report), 76512 (ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan), and 67820 (correction of trichiasis; epilation, by forceps only). New values for these services will go into effect in the coming years. These surveys were sent to a total of 2,250 doctors of optometry. In total, AOA received feedback from only 22 doctors.
If you receive a survey related to valuing a CPT code, please participate. Your feedback is critical for developing appropriate values for the services that doctors of optometry provide.
Changes in coding and reimbursements worth knowing. Meanwhile, with the clock winding down on 2024, the AOA continues to press for Congress to act on reforms that would give doctors of optometry an annual, permanent inflationary Medicare payment tied to the Medicare Economic Index.
The federal government and private payers are heavily scrutinizing the use of modifier -25. When used appropriately, it can help to ensure that patients receive appropriate treatment and that doctors of optometry are reimbursed appropriately for their service. If you believe a claim that includes modifier -25 was inappropriately denied, follow appropriate criteria when appealing.