Eyeworld

EW MEETING REPORTER 116 March 2011 Medicare Reimbursement Challenges E. Ann Rose, president, Rose & Asso- ciates, Duncanville, Texas, went over new CPT codes, as well as common mistakes found in audited practices, in the ASOA session Medicare Reim- bursement Challenges. There are two new codes this year for the placement of amniotic membrane on the ocular surface. "For wound healing, 65778 is self-re- taining," she said. "Code 65779 is single layer, sutured. You use these codes to report the placement of preserved amniotic membrane over damaged ocular surface areas for wound repair and healing." These codes cannot be reported when you are doing corneal scrap- ing, removal of the epithelium, or with ocular surface reconstruction. If amniotic tissue is applied with glue, you must use code 66999. Also of note, code 66761 for iri- dectomy has gone to a 10-day global fee period. "The good news is now you can do any additional treat- ments or post-op follow-up after 10 days," said Ms. Rose. "The bad news is that when [Medicare] reduced the global fee period, it reduced the fee. Iridectomy went down about $100." For the review portion of the discussion, Ms. Rose acknowledged that although some of the points may seem elementary to some ad- ministrators, they remain "big prob- lematic issues." For example, some practices are still having problems with code 66982 for complex cataract surgery. "It's to be used for the management of complicated cases such as previ- ous trauma, concurrent disease states, and congenital abnormali- ties," she said. "It is not intended for mishaps during regular cataract sur- gery." It is also not to be used for vit- rectomy required during surgery, piggyback IOLs, loose zonules, or in- traocular bleeding, among other things. "If any of those things do hap- pen and your 7-minute cataract sur- gery becomes 30 or 45 minutes, you need to append the -22 modifier and send in an operative report," Ms. Rose said. "Most often what you'll get is more than what you would have gotten for the 66982 by billing it wrong. And I suggest you bill it. You should be paid for your extra time." Editors' note: Ms. Rose has financial in- terests with Rose & Associates, Alcon, and Heidelberg Engineering (Vista, Calif.). Reporting live from ASCRS Winter Update, Palm Beach, Fla. by Jena Passut and Faith A. Hayden Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team. continued from page 115 Guest of honor: Norman Jaffe Sessions continued Saturday, Jan. 29, with a speech by guest of honor, Norman S. Jaffe, M.D. Dr. Jaffe, a pioneer of IOL implantation in the U.S., was a founding member and second president of ASCRS, formerly the American Intra-Ocular Implant Society. "Dr. Jaffe was one of the most prominent advocates for the use of intraocu- lar lenses during those hectic days when there was a lot of hostility toward their use both in the United States and abroad," said Stephen S. Lane, M.D., clinical professor of ophthalmology, University of Minnesota, Minneapolis. "His careful approach to the surgery and, more importantly, the guidelines he helped establish were lauded by many in both academia and the private sector and were really the guidelines that have led us to where we are today." Dr. Jaffe credits IOL endurance to several factors, including a rousing en- dorsement by the actor who played Marcus Welby, M.D., on television. Robert Young, who was nearly blind from cataracts and had to give up acting, testified during a 1980 FDA hearing to ban IOLs that the innovation had saved his career and "should be available to all Americans." The message resonated, and the FDA backed off. "If implants were good enough for Marcus Welby, M.D., they're good enough for the nation," Dr. Jaffe said. Other events that "made it clear implants were here to stay" were a 2-year moratorium on the procedure that allowed non-implant surgeons to evaluate its efficacy and the formation of AIOIS (later ASCRS), Dr. Jaffe said. continued on page 118

• Cover