Retinal Physician

JAN-FEB 2017

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14 R E T I N A L P H Y S I C I A N . C O M | N O V E M B E R / D E C E M B E R 2 0 1 6 R E T I N A L P H Y S I C I A N | J A N U A R Y / F E B R U A R Y 2 0 1 7 14 O nce again this year we see coding and reimbursement changes. Q What CPT coding changes are slated for 2017? A ere are a number of changes per- tinent to retinal specialists, including one new Category I CPT code. In our consulting practice, we don't see this combination frequently, but it does happen. • 92242 Fluorescein angiography and indocyanine-green angiogra- phy (includes multiframe imag- ing) performed at the same patient encounter with interpretation and report, unilateral or bilateral e descriptions of these codes changed. • 67101 Repair of retinal detach- ment, 1 or more sessions including drainage of subretinal fluid when performed; cryotherapy • 67105 Repair of retinal detach- ment, 1 or more sessions including drainage of subretinal fluid, when performed; photocoagulation • 92235 Fluorescein angiography (includes multiframe imaging) with interpretation and report, unilateral or bilateral • 92240 Indocyanine-green angiog- raphy (includes multiframe imag- ing) with interpretation and report, unilateral or bilateral CPT 67101 and 67105 include minor changes to the description, and there are also changes to the global surgery period for these codes. e changes to 92235 and 92240 are espe- cially significant, because both codes have been defined as unilateral until now. Medicare and most other pay- ers consider "unilateral or bilateral" to mean bill once whether one or both eyes are tested. See Table 1 for the financial impact of these changes. A number of new Category III codes were to become effective January 1. ese are pertinent to retina. • 0444T Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral • 0445T Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including re-train- ing, and removal of existing insert, unilateral or bilateral • 0465T Suprachoroidal injection of a pharmacologic agent (does not include supply of medication) (To report intravitreal injection/ implantation, see 67025, 67027, or 67028) Be advised that coverage and pay- ment for Category III codes remain at the discretion of the Medicare Administrative Contractor (MAC). Q What is slated to happen with the Medicare Physician Fee Schedule as of January 1? A e 2017 conversion factor is $35.8887, which is a slight increase from the 2016 conversion factor of $35.8043. It includes a budget neutral- ity adjustment of -0.013%, an increase of 0.5% resulting from MACRA, and a misvalued code reduction target adjustment of -0.18%. Relative Value Unit (RVU) changes also are expected to occur on Jan. 1. e net result of all these changes is approximately a 2% reimbursement reduction for ophthalmology services overall. Some retina procedure codes were revalued to the RUCs original recommended RVUs after taking sig- nificant reductions in 2016. What's New for 2017? SUZANNE L. CORCORAN, COE C O D I N G Q & A Suzanne L. Corcoran, COE, is executive vice president and founder of Corcoran Con- sulting Group (CCG), San Bernardino, CA, which specializes in coding and reimburse- ment issues for ophthalmic practices. 67101 Repair detached retina cryotherapy -58% 67105 Repair detached retina photocoagu- lation -59% 67107 Repair detached retina scleral buckle +12% 67110 Repair detached retina pneumatic retinopexy +16% 92235 Fluorescein angiog- raphy -22% 92240 ICG angiography -18% Table 1. There are some significant changes pertinent to retina, especially to physician work RVUs:

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