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EW OB January 2011 65 Tabular Addenda 365 Glaucoma 365.4 Glaucoma associated with congenital anomalies, dystrophies, and systemic syndromes 365.44 Glaucoma associated with systemic syndromes Code first associated disease, as: Re- vise neurofibromatosis (237.70- 237.79) 374 Other disorder of eyelids 374.8 Other disorders of eyelid 374.86 Retained foreign body of eye- lid Add Use additional code to identify foreign body (V90.01 – V90.9) 376 Disorder of the orbit 376.6 Retained (old) foreign body following penetrating wound of orbit Add Use additional code to identify foreign body (V90.01-V90.9) MISCELLANEOUS Other miscellaneous changes that you should read in your new CPT: • Descriptive changes to modifiers 76, 77 and 78 in the modifier ap- pendix • Coding by Time in the Introduc- tion and read the description of intraservice time found under the E/M service guidelines • The professional addition has cod- ing tips and the one on Transfer of Care is important • Ocuoloplastics–read the instruc- tions and changes in the Integu- mentary System OIG WORKPLAN FOR 2011 The following excerpts are taken from the Office of the Inspector General's (OIG) Work Plan for this year. The boldface type was added to make sure you don't miss it! Place of Service Errors We will review physician coding of place of service on Medicare Part B claims for services performed in ambulatory surgical centers (ASC) and hospital outpatient depart- ments. Federal regulations at 42 CFR § 414.32 provide for different levels of payments to physicians depend- ing on where the services are per- formed. Medicare pays a physician a higher amount when a service is per- formed in a nonfacility setting, such as a physician's office, than it does when the service is performed in a hospital outpatient department or, with certain exceptions, in an ASC. We will determine whether physi- cians properly coded the places of service on claims for services pro- vided in ASCs and hospital outpa- tient departments. work in progress) Coding of Evaluation and Management Services We will review evaluation and management (E&M) claims to iden- tify trends in the coding of E&M services. Medicare paid $25 billion for E&M services in 2009, represent- ing 19 percent of all Medicare Part B payments. Pursuant to CMS's Medicare Claims Processing Manual, Pub. No. 100 04, ch. 12, § 30.6.1, providers are responsible for ensur- ing that the codes they submit accu- rately reflect the services they provide. E&M codes represent the type, setting, and complexity of services provided and the patient status, such as new or established. We will review E&M claims to deter- mine whether coding patterns vary by provider characteristics. Payments for Evaluation and Management Services We will review the extent of po- tentially inappropriate payments for E&M services and the consistency of E&M medical review determina- tions. CMS's Medicare Claims Pro- cessing Manual, Pub. No. 100 04, ch. 12, § 30.6.1 instructs providers to "select the code for the service based upon the content of the service" and says that "documentation should support the level of service re- ported." Medicare contractors have noted an increased frequency of medical records with identical documentation across services. We will also review multiple E&M services for the same providers and beneficiaries to identify elec- tronic health records (EHR) docu- mentation practices associated with potentially improper pay- ments. Evaluation and Management Services During Global Surgery Pe- riods We will review industry prac- tices related to the number of E&M services provided by physicians and reimbursed as part of the global sur- gery fee. CMS's Medicare Claims Pro- cessing Manual, Pub. No. 100 04, ch. 12, § 40, contains the criteria for the global surgery policy. Under the global surgery fee concept, physi- cians bill a single fee for all of their services that are usually associated with a surgical procedure and related E&M services provided during the global surgery period. We will determine whether industry practices related to the number of E&M services provided during the global surgery period have changed since the global sur- gery fee concept was developed in 1992. EW ABOUT THE AUTHOR Riva Lee Asbell is principal of Riva Lee As- bell Associates, an ophthalmic reimburse- ment consulting firm located in Fort Lauderdale and a nationally known con- sultant. Her most recent academic ap- pointment is clinical assistant professor of surgery (ophthalmology), University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Camden, N.J. Friday Focus Surveys are a member benefit of the American Society of Ophthalmic Administrators. For membership information contact asoa@asoa.org or 703-591-2220. ASOA, 4000 Legato Road, Suite 700, Fairfax, VA 22033. www.asoa.org. ASOA Friday Focus Surveys Focusing on the BUSINESS of Ophthalmology 1. Does your practice perform Exit Interviews? Response percent Yes 65% No 35% Beginning with our re- design for 2011, EyeWorld is changing the name of its' Practice Management section to Ophthalmology Business to coincide with its' new publication. Oph- thalmology Business will be published quarterly as an insert into EyeWorld and will have an e-Zine published 4 times a year. Ophthalmology Business will feature detailed aspects of managing a practice, achieving a platinum level of customer service, wealth management pearls, estate & tax planning, and much more. We hope you come to rely on this publication as your "go to" resource for helping your practice excel. An ASCRS Publication NOVEMBER 2010 VOL. 1, No. 1 www.OphthalmologyBusiness.org FORCED TO ACCEPT MEDICARE pg. 10 SEEING EYE-TO EYE pg. 24 10 common marketing mistakes pg. 22 pg. 14 TM MANAGE AND GROW YOUR PRACTICE IN TOUGH TIMES pg. 18 View the latest publication online at www.OphthalmologyBusiness.org

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