Eyeworld

EW FEATURE 36 by Jena Passut EyeWorld Staff Writer Rules on how to charge for femto procedure get muddied, some say Some doctors, experts say CMS rules are clear on how to charge W hile some have her- alded the invention of the femtosecond laser as "the future of cataract surgery," one question remains in the forefront of many surgeons' minds: How can they charge for the expensive tech- nology? One thing seems clear. The pro- cedure on a medically necessary cataract, no matter how it is per- formed, is covered under Medicare. Surgeons can't charge patients for using the femtosecond laser during cataract surgery, despite the laser's reported advantages, including more precise and adjustable capsulo- tomies, as well as using less phaco energy. "The incision into the anterior chamber, the capsulorhexis, and lens fragmentation are all part and parcel of a covered cataract proce- dure. Surgeons cannot charge bene- ficiaries extra for that," said Nancey McCann, ASCRS director of govern- ment relations. Kevin J. Corcoran, C.O.E., C.P.C., F.N.A.O., president, Corcoran Consulting Group, San Bernardino, Calif., agreed. Mr. Corcoran's consulting practice pro- vides many ophthalmologists with assistance on reimbursement issues and compliance. "The surgical instrument is not the key distinction in a reimburse- ment context," he said. "This is cataract surgery, however it is per- formed." Medicare and commercial payers don't distinguish how the procedure is performed and pay ac- cordingly, said William L. Rich III, M.D., Fairfax, Va., American Academy of Ophthalmology's (AAO) medical director of health policy. "They don't care if you made the opening in the eye with a dis- posable metal blade, a diamond blade, or a laser," Dr. Rich said. "They don't care how you open the capsulorhexis, or whether you use a bent needle that costs $2 or a Fugo blade or a femtosecond laser. They don't care because it's all covered under the fee. Neither the surgeon nor the facility can charge any more for the use of a femtosecond laser on a medically necessary cataract." The technology is expensive for the surgeons or ambulatory surgery centers who wish to employ it for cataract surgery. One must take into consideration the upfront cost of the laser as well as the click fee. Compa- nies may also charge considerable sums for maintenance contracts. So how can surgeons employ this impressive technology and get reimbursed for it? "I feel comfortable saying that this is a refractive procedure," said Eric D. Donnenfeld, M.D., clinical professor of ophthalmology, New York University, who began using the laser for refractive cataract sur- February 2011 Laser-assisted cataract surgery July 2011 Why continued from page 36 Dr. Safran said, "What we are doing now is the gold standard against which the laser will have to prove itself. Not the other way around. To charge extra for some- thing that has not yet proven itself in this manner seems wrong to many of us. To claim it is better at this point is just false." Final points Nothing in life is all bad, and some of the surgeons EyeWorld spoke with were quick to point this out. Drs. Oren, Safran, and Wortz, for exam- ple, acknowledged that laser-assisted cataract surgery has the potential to level the playing field, taking a poor or average surgeon and making him or her above average. But is that nec- essarily a good thing? "What is going to happen is it's going to make the surgeons with a high complication rate much better, but it may not make surgeons with a low complication rate better," said Dr. Wortz. "In fact, it might make them worse. The laser's complication rate is going to be everyone's com- plication rate." "Sure, there are guys out there who are lousy surgeons that might benefit," said Dr. Safran. "But is it fair to allow lousy surgeons to charge patients more so they can have a decent capsulorhexis?" Dr. Wortz admitted that al- though he doesn't believe the tech- nology has a tangible benefit right now, that doesn't mean it won't in the future. "I think there may be advan- tages down the road that we can't foresee right now," he said. "I never want to bet against new technology. Maybe we don't see all the benefits right now, but that may be because we're not creative enough in our thinking and haven't caught the vi- sion of what it's going to be." EW Editors' note: None of the physicians interviewed have financial interests related to their comments. Contact information Kim: kim@professionaleye.com Oren: rlodad@bellsouth.net Safran: safran12@comcast.net Wortz: 2020md@gmail.com AT A GLANCE • Procedures on a medically neces- sary cataract, including pre- and post-op, are covered by Medicare • Surgeons can charge for using the laser for astigmatic reduction with PCRIs • A business plan needs to be put in place before a huge purchase, ex- perts say Dr. Cionni performing femto cataract surgery Source: Robert J. Cionni, M.D.

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