Eyeworld

UPDATE 10 ASCRS member spotlight: Kendall Donaldson, MD by Denise Monasterio ASCRS Marketing and Communications Manager tute. She completed her residency training and cornea/external disease fellowship at the Bascom Palmer Eye Institute in 2004. Prior to residency training, she completed a master's degree in anatomy and physiology and managed the laboratory courses for the pre-professional program at the University of Maryland. During her ophthalmology training, Dr. Donaldson pursued a certificate pro- gram in management through the Wharton School for Business. Interested in becoming a volun- teer with ASCRS? Visit ascrs.org/vol- unteer. For more information on the ASCRS Foundation and Operation Sight, visit ASCRSFoundation.org. Not a member? Joining is easy. Visit ascrs.org/join for full information. EW Contact information Monasterio: dmonasterio@ascrs.org Her team produced a webinar in October 2018, "Customizing Cat- aract Surgery." The webinar will be featured as an instructional course during the 2019 ASCRS•ASOA Annual Meeting in San Diego on Monday, May 6, from 1:00–2:30 p.m. Dr. Donaldson will also be speaking during the "Mastering It All" symposium on Sunday, May 5, from 1:00–2:30 p.m. Dr. Donaldson serves on the ASCRS Cataract Clinical Committee and has co-authored papers and spoken in numerous educational symposia regarding cataract surgery. She has led numerous courses over the years and has participated and led various webinars. She also partic- ipates as a Skills Transfer lab instruc- tor at both the Annual Meeting and Combined Ophthalmic Symposium. Dr. Donaldson is the medical director and a professor of clinical ophthalmology and cornea specialist at the Bascom Palmer Eye Insti- volunteerism from the individuals who serve as educators. Every month, we feature one of these member volunteers. We intro- duce you to individuals who have contributed to the society's out- standing education and initiatives, helping members strengthen their skills and sharpen their expertise, and provide better care to patients. To honor National Women Physicians Day on February 3, this month's spotlight member is Kend- all Donaldson, MD. Dr. Donaldson has been a member of ASCRS for more than 18 years. She is a dynam- ic leader and serves as the chair of the ASCRS Refractive Cataract Sub- committee. Her team has published numerous review papers. In 2018, her subcommittee published two re- view papers in the Journal of Cataract & Refractive Surgery: "Perioperative Assessment for Refractive Cataract Surgery" and "Medical and Surgical Management of the Small Pupil." A SCRS is, at its core, a member-led organization. Much of the education, information, and other offerings are developed by anterior segment specialists for ante- rior segment specialists. The success of the organization is highly impact- ed by the continued dedication and Kendall Donaldson, MD C orneal collagen crosslink- ing provides a treatment that can stop the progres- sion of keratoconus and ectasia after refractive surgery. There is optimism that initial reimburse- ment challenges will be reduced now that the approved Photrexa medication for the procedure has a unique J code, which allows insurance carriers to establish a price for the medication unit. Since the FDA approved the Avedro KXL System with Photrexa and Photrexa Vis- cous in April 2016, ophthalmic practices have billed this ser- vice with a Category III CPT, 0402T – Collagen crosslinking of cornea (including removal of the corneal epithelium and intraoperative pachymetry when performed) and an unspecified HCPCS Code, J3490 – Unspeci- fied medication. New technology codes and unspecified codes pose specific challenges to reimburse- ment. New technology codes have no RVUs assigned to them and therefore often lack a set fee Coding and reimbursement update for corneal collagen crosslinking schedule amount, while the unspec- ified J codes cause numerous claim submission formatting challenges. ASCRS worked diligently with the ophthalmic community to address the lack of a specific J code and is pleased to share a summary of guidelines for correct coding of crosslinking as of January 1, 2019. ASCRS and ASOA strongly encour- age ophthalmologists and adminis- trators who offer crosslinking to go to ascrs.org/Corneal_Cross_Linking_ Billing_Guidelines for details. January 1, 2019 correct coding While the Category III code, 0402T, will remain for the procedure, as of January 1, the unspecified J code no longer needs to be used. CMS has released a new, specific HCPCS code for the medication used in corneal crosslinking, effective as of January 1, 2019. • 0402T: Collagen crosslinking of cornea (including removal of the corneal epithelium and intraop- erative pachymetry when per- formed) • J2787: Riboflavin 5'– Phosphate, ophthalmic solution, up to 3 ml Since the procedure requires the use of 6 ml of solution, offic- es should submit 2 units of J2787 when performing the corneal cross- linking procedure. The NDC number and descrip- tion for the Photrexa crosslinking kit remain: • NCD 25357-025-03: Photrexa crosslinking kit Many carriers require that you submit claims with an 11 digit NDC. To convert the 10 digit NDC to 11 digits, add a zero to the NDC as fol- lows: 25357-0025-03. It is important to add this new HCPCS code to your charge master effective January 1, 2019 and that you have appropriate- ly programmed in the NDC so it is ready for procedures performed after January 1, 2019. Claims for date of service through December 31, 2018 should still be submitted with J3490 – Unspecified medication. Commercial carrier coverage The existence of a CPT code and a specified medication code does not ensure coverage, however. You still should verify coverage before performing each proce- dure. • Weighted Average Cost (WAC): As of December 2018, the WAC per package is $2,850. The WAC per unit would be $1,425. • Average Wholesale Pricing (AWP): As of December 2018, the AWP is $3,420. The AWP per unit would be $1,710. It should be noted that while many insurance carriers do not require prior authorization for outpatient surgical proce- dures, they may require one for 0402T because it is a new tech- nology code and many do require prior authorization for billable medications such as J2787. Make sure your office verifies the requirements of each insurance carrier. EW Contact information Nancey McCann: nmccann@ascrs.org

• Cover