Meeting News Coverage

Speaker updates clinicians on Medicare reimbursement, coding

WAIKOLOA, Hawaii — Even though changes are looming, over the past 10 years, there have not been significant changes in reimbursement; however, many CPT codes have had an adjustment in their relative value units, which are the drivers of reimbursements, according to a speaker here.

Over the past year, there were some positive changes to the RVUs, as well as some decreases, Donna McCune, vice president of Corcoran Consulting Group, told ophthalmologists gathered at the joint opening of Hawaiian Eye 2013 and Retina 2013.

Donna McCune

Donna McCune

“Certainly for the cataract surgeons … you are deeply disturbed by the fact that cataract surgery did take a 12% reduction in RVUs for traditional cataract surgery and a 25% reduction for complex cataract surgery,” McCune said.

Regarding RVUs for endothelial cell counts, McCune said that there will be a correction. Currently, there is a 70% reduction in the RVU table, but the real reduction is 23%.

“That’s certainly better than 70%,” she said. “Stay tuned.”

For physicians with ownership in ambulatory surgery centers, “Note that you took a 0.6% increase in facility fees,” McCune said. The numbers reflect national interests from 2011 to 2013, she said. Hospitals received a 1.8% increase in facility fees, she said.

A new CPT code this year is 64615, which is of interest to ophthalmologists, she said, because it involves chemodenervation of muscle or muscles innervated by the facial nerve, such as for treatment of chronic migraines.

“I want to point out that this cannot be reported at the same time as reporting a code for blepharospasm, the 64612 code. An adjustment to the 64612 code was also made, that is, it was clarified to indicate that it is a unilateral procedure,” McCune said.

Over the past couple of months, one code — 0191T — has been used and approved for payment, McCune said. The code was established in anticipation of approval of the Glaukos iStent, which received U.S. Food and Drug Administration approval in June 2012 and can be used in conjunction with cataract surgery.

“Keep in mind that when you bill for two procedures, one is reduced by 50%. From everything that we have heard thus far, the recommendation is to bill this procedure as primary and bill your cataract procedure as secondary,” McCune said.

Disclosure: McCune is a consultant for the Corcoran Consulting Group.

WAIKOLOA, Hawaii — Even though changes are looming, over the past 10 years, there have not been significant changes in reimbursement; however, many CPT codes have had an adjustment in their relative value units, which are the drivers of reimbursements, according to a speaker here.

Over the past year, there were some positive changes to the RVUs, as well as some decreases, Donna McCune, vice president of Corcoran Consulting Group, told ophthalmologists gathered at the joint opening of Hawaiian Eye 2013 and Retina 2013.

Donna McCune

Donna McCune

“Certainly for the cataract surgeons … you are deeply disturbed by the fact that cataract surgery did take a 12% reduction in RVUs for traditional cataract surgery and a 25% reduction for complex cataract surgery,” McCune said.

Regarding RVUs for endothelial cell counts, McCune said that there will be a correction. Currently, there is a 70% reduction in the RVU table, but the real reduction is 23%.

“That’s certainly better than 70%,” she said. “Stay tuned.”

For physicians with ownership in ambulatory surgery centers, “Note that you took a 0.6% increase in facility fees,” McCune said. The numbers reflect national interests from 2011 to 2013, she said. Hospitals received a 1.8% increase in facility fees, she said.

A new CPT code this year is 64615, which is of interest to ophthalmologists, she said, because it involves chemodenervation of muscle or muscles innervated by the facial nerve, such as for treatment of chronic migraines.

“I want to point out that this cannot be reported at the same time as reporting a code for blepharospasm, the 64612 code. An adjustment to the 64612 code was also made, that is, it was clarified to indicate that it is a unilateral procedure,” McCune said.

Over the past couple of months, one code — 0191T — has been used and approved for payment, McCune said. The code was established in anticipation of approval of the Glaukos iStent, which received U.S. Food and Drug Administration approval in June 2012 and can be used in conjunction with cataract surgery.

“Keep in mind that when you bill for two procedures, one is reduced by 50%. From everything that we have heard thus far, the recommendation is to bill this procedure as primary and bill your cataract procedure as secondary,” McCune said.

Disclosure: McCune is a consultant for the Corcoran Consulting Group.

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