Eye Global Surgery E/M Services Under Scrutiny

The Centers for Medicare & Medicaid Services (CMS) reimbursed physicians approximately $1.6 billion for major eye global surgeries performed in 2005. About $97.6 million of those Medicare payments were for evaluation and management (E/M) services included in eye global surgery fees that were more than likely not provided during global surgery periods, according to an Office of Inspector General (OIG) audit.

CMS compensates physicians for surgical services and related E/M services included in the fees regardless of the E/M services actually provided during global surgery periods.

Evaluation and Management – CEMC

The OIG found that eye global surgery fees often (240 of the 300 surgeries the OIG sampled) did not reflect the number of E/M services physicians actually provided to beneficiaries during global surgery periods.

“Specifically, physicians provided fewer E&M services than were included in 201 global surgery fees and provided more E&M services than were included in 39 global surgery fees,” the April 20 OIG report states.

The reason being, according to the OIG report, is that CMS has not adjusted the relative value units (RVUs) for most of the sampled surgeries.

In the report, the OIG recommends CMS:

  • Adjust the estimated number of E/M services within eye global surgery fees; or
  • Use the financial results of the audit during the annual update of the physician fee schedule.

CMS requested the OIG conduct review of E/M services included in eye and ocular adnexa (eye) global surgery fees for 2005. CMS’ response, however, was that further analysis is needed before proposing any changes in the number of E/M services assigned to eye global surgeries.

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5 Responses to “Eye Global Surgery E/M Services Under Scrutiny”

  1. patrick rush says:

    Here it goes

  2. Jennifer Daffin says:

    Interesting.

  3. gladys newberry says:

    Good job. It would only be fair to recover if this is not being done voluntarily

  4. Ken Singh says:

    Providers and their staff should know better. A voluntarily refund should be issued to Medicare in an attempt to prevent an onsite audit.

  5. Patti James says:

    This is why we have modifiers and good documentation.

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