Retinal Physician

JAN-FEB 2017

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15 R E T I N A L P H Y S I C I A N | N O V E M B E R / D E C E M B E R 2 0 1 6 In addition, the global surgery period for 67101 and 67105 will change from 90 days to 10 days. As with PRP (67228) last year, this adds to the financial impact for the Medicare fee schedule. We also note that the new combination angiogra- phy code (92242) has a greater value than either component (92235 and 92240) but much less than the com- bined values of these codes in 2016. Q Are there changes for ASCs and HOPDs? A Yes, there are small increases in facility reimbursement in 2017 for most codes. For ambulatory surgery centers, the wage adjustment for bud- get neutrality, in addition to the mul- tifactor productivity adjusted update factor, increases the ASC conversion factor by 1.9% overall for those meet- ing the quality reporting require- ments. Various adjustments to hospital reimbursements result in an over- all hospital outpatient department (HOPD) rate increase of 1.65%. As with professional fees, there are a few big winners and losers for retina surgery facility fees. And, due to the differences between how ASC and HOPD fees are set, the changes are not always of the same magnitude or go in the same direction (Table 2). Q ere were many ICD-10 changes; did they transition well? A e October 1, 2015, ICD-10 transition was relatively smooth. Unfortunately, the first major update of ICD-10 codes on October 1, 2016, has not gone as well as the original implementation in 2015. e update included 1,974 new codes, 311 deleted codes, and 425 revised codes. ere were major updates for diabetic eye diseases and AMD. Some Medicare contractors and other payers were tardy in updating local policies and edits or did so incor- rectly. Hopefully most issues have been resolved by now. See October's Coding Q&A column for more dis- cussion about the changes. http:// tinyurl.com/hxlvmmm Q We've heard about new telehealth codes. What can you tell us? A As telehealth continues to evolve in healthcare, so do coding changes to designate such services. Effective January 1, 2017, a new place of service code, POS 02 – Telehealth – is slated to become effective. Described as: e location where health services and health related services are provided or received, through telecommunication technology," it is used by the physician or practitio- ner furnishing telehealth services from a remote site. In the same CMS instruction document on the new POS, it reminds providers that one of two modifiers is required when billing Medicare for telehealth services. • GT – via interactive audio and video telecommunications systems • GQ – via an asynchronous telecom- munications system For CPT 2017, a new telehealth modifier is being added. • 95 – Synchronous Telemedicine Service Rendered Via a Real- Time Interactive Audio and Video Telecommunications System Unfortunately, this modifier may only be appended to a specific list of CPT codes for services typically performed face-to-face but may be rendered via real-time (synchronous) interactive audio and video telecom- munications system. Find the codes in Appendix P of the 2017 CPT Manual. ey include evaluation and man- agement (E/M) codes and two remote imaging codes, 92227 (Remote imag- ing for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physi- cian supervision) and 92228 (Remote imaging for monitoring and manage- ment of active retinal disease (eg, dia- betic retinopathy) with physician review, interpretation and report, unilateral or bilateral). CPT 92250 (Fundus pho- tography, with interpretation and report) is not included on the list of approved codes for telehealth. It is important to remember that any telehealth service must be live and interactive for Medicare coverage. is limits its applicability, at least for now. Other payers, however, may be more amenable. RP 15 R E T I N A L P H Y S I C I A N . C O M | J A N U A R Y / F E B R U A R Y 2 0 1 7 ASC HOPD 67027 Implant intravitreal drug system - 31% + 28% 67036 Mechanical vitrectomy, pars plana + 79% + 96% 67041 Vitrectomy for macular pucker + 79% + 96% 67101 Repair detached retina cryotherapy - 57% + 5% 67105 Repair detached retina photocoagulation - 31% + 7% 67115 Release encircling material + 79% + 96% Table 2. ASC and HOPD changes

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