4Amniotic Membrane65778 Placement of of amniotic membrane on the ocular surface for wound healing; self-retainingRecurrent corneal erosion, infectious/inflammatory keratitis, herpes, superficial epithelial defects, severe dry eye, cornea disease.
5Amniotic MembraneFor healing persistent epithelial defects, ulcers. When bandage CL needed, want inflammation control, but cant use steroid.$1469 (Medcr) Cost $800Paid by Medicare in several states.
7Scanning Laser for Plaquenil V58.69 Long term (current) use of other medications; Other high-risk medicationsNine Medicare Part B contractors:6 approve V58.69 (Novitas, CGS, First Coast, NGS, NHIC, WPS). Three (Cahaba, Noridan, Palmetto) are silent about V they have no LCD for OCT.
8Scanning Laser for Plaquenil States with Cahaba, Noridan, Palmetto: if with V58.69 is denied (as in the past), submit an appeal, giving evidence that Novitas, CGS, First Coast, NGS, NHIC, WPS pay for V Chances are good the contractor will reverse its decision and it will be paid.
10MedicareOPPS - Medicare put payment cap on some diagnostic imaging services, based on fee caps of Hospital Outpatient Prospective Payment System (OPPS).The only optometric code affected is Fundus Photography.
11MedicareMPPR - Medicare reduces payment on some diagnostic ophthalmology procedures, when two (or more) are billed on the same day.The MPPR (Multiple Procedure Payment Reduction) reduces payment on the 2nd code (and the 3rd, 4th, etc).
12MedicareMPPR –The first diagnostic procedure is paid at the normal rate. The first diagnostic procedure is defined as the one with highest value.
15MedicareSEQUESTRATION - Federal budget problems resulted in an overall 2% reduction of physician pay.Medicare pays the physician 78% of the allowed payment, and the patient still owes 20% of the Allowed Payment.Allowed Payment remains the same.file://localhost/Users/alanhomestead/Documents/My Documents B /Adventures /1 AccuFee/2013/AccuFee 2013 Files XLSX/1 AccuFee xlsx
17Using Glaucoma Stage Code Select ICD code for type of glaucoma (same as past) from 38 glaucoma codes (365.xx)
18If selected code is one of 11 (below), add Glaucoma Stage code in 2nd position on claim form Open-angle glaucoma, unspecifiedPrimary open angle glaucomaLow tension glaucomaPigmentary glaucomaPrimary angle-closure glaucoma, unspecified
19365.23 Chronic angle-closure glaucoma Corticosteroid-induced glaucoma, glaucomatous stagePseudoexfoliation glaucomaGlaucoma associated with ocular inflammationsGlaucoma associated with vascular disordersGlaucoma associated with ocular trauma
20Select Glaucoma Stage code (physicians judgment) Glaucoma stage, unspecifiedNo documentation regarding stage of glaucomaMild stage glaucomaOptic nerve changes consistent with glaucomaNo VF loss on white-on-white perimetryVF loss may be on short-wavelength automated perimetry or frequency-doubling perimetry
21 365.72 Moderate stage glaucoma 365.73 Severe stage glaucoma Optic nerve changes consistent with glaucomaVF loss in one hemifieldNot within 5° of fixationSevere stage glaucomaOptic nerve change consistent with glaucomaVF loss in both hemifieldsVF loss within 5° of fixation in at least one hemifield
22Glaucoma stage cannot be determined Indeterminate stage glaucomaGlaucoma stage cannot be determinedHad no time to do VFPatient can’t do VFVF unreliable or uninterpretable, so stage of glaucoma is unsureDo not confuse with which is no documentation regarding stage of glaucoma
23Bilateral Glaucoma Same type and stage Report one code for type of glaucoma, and one Glaucoma stage codeSame type but different stageReport one code for type of glaucoma, and one Glaucoma stage code for the highest glaucoma stageEach eye different type and different stageReport two codes, one for each type glaucoma, and one Glaucoma stage code for highest glaucoma stage
24Claim FormEnter stage code adjacent to glaucoma diagnosis Report with office visit code and every related procedure done during visit
25Secondary Codes Glaucoma stage codes are secondary add-on codes Glaucoma stage codes are not principal or first-listed or primary diagnosis codes
26HIPAA Adherence to ICD guidelines is required by HIPAA HIPAA applies to anything transmitted electronicallySome plans may be slow to recognize new codes
27PAYMENT IF NOT REPORTED? Florida MAC says YesNoridian?WPS?Non-Medicare?
28INFORMATION Teaching tool by AGS Google “American Glaucoma Society” Google “American Glaucoma Society”
29CPT CODESDeleted Fitting of contact lens for treatment of disease, including supply of lens
30CPT CODESNew 201292071Fitting of contact lens for treatment of ocular surface diseaseReport supply of lens separately with or V code
31CPT CODESNew 201292072Fitting of contact lens for management of keratoconus , initial fittingReport supply of lens separately with or V codeSubsequent fittings, report 99 or 92 office call code
32Remote ImagingNew in 2011Remote imaging for detection of retinal diseaseandRemote imaging for monitoring and management of active retinal disease
33Remote ImagingNew in Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral.
34Remote Imaging92227 This code has no physician work and is intended for use by non-physician readers For detection or screening for retinopathy Used when it is unknown if patient has retina disease - just looking for it
35Remote ImagingNew in Remote imaging for monitoring and management of active retinal disease (eg, diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral.
36Remote Imaging92228 When patient has active retinopathy being managed For physicians involved with remote imaging
37Remote Imaging92228 example Separate entity (eg reading center) owns imaging system It is placed in PCP office PCP staff takes image
38Remote Imaging 92228 example Image is sent to OD/OMD for I&R Reading center staff provides I&R, under physician supervisionPCP bills w/ TC,OD/OMD/Reading center bills w/ 26
39Remote Imaging92228 example $21.43 (Medicare 2013)
40Deleted CPT92120 Tonography; recording indentation tonometer or perilimbal suction92130 Water provocation tonography
42ICD-10 ICD-10-CM “Benefits” Measure quality, safety, efficacy of care Reduce need for attachments to explain pt’s conditionDesign payment systems & process claims for paymentConduct research, epidemiological studies, clinical trialsSetting health policyOperational and strategic planningDesigning health care delivery systemsMonitor resource useImprove clinical, financial, administrative performancePrevent and detect health care fraud and abuseTrack public health and risks
43TearLab Osmolarity Test Waived Test Approval Effective January 1, 2012 CMS pays in each state $23.25 per eye
44DMEPOSFee January 1, 2013 application fee for CMS 855S for enrollment or revalidation with DME is $523 Fee will remain $532 until December 31, 2013 (was $505, $523)
45DMEPOSDurable Medical Equipment, Prosthetics, Orthotics, and Supplies Can you sell post cataract glasses if not a provider?
46Medicare CFConversion Factor January 1, 2013 to December 31, 2013
47Medicare ABNAdvanced Beneficiary Notice ABN Form CMC-R-131 (03/11) Only acceptable version after January 1, 2012
48LCDfile://localhost/Users/alanhomestead/Documents/My Documents B /Adventures /O - S/Presentations/Repository of My PowerPoints/1 Topic Modules/LCD/LCD Aug 13.pptx