Medicare Compliance & Reimbursement

Plus: Prepare to see a new path to bill for retina surgeries

Heads up: CPT 2008 will eliminate retina surgery code 67038 (Victrectomy, with epiretinal membrane stripping). Instead, you'll have three new retina surgery codes to choose from.

Patients may have an epiretinal membrane on the surface of the macula because of a previous infection or the results of a past surgery, note experts. The membrane can cause a distortion in vision. Your doctor may also refer to this phenomenon as "macular pucker" or "cellophane maculopathy."

You'll also have a new code for complex retinal detachment procedures in 2008, sources close to the process say. And you'll have a new separate "J" code for reporting Lucentis, a popular drug for age-related macular degeneration.

Other new CPT 2008 changes coming down the pike next year:

• The descriptor for Fecal Occult Blood Test (FOBT) code 82272 will change. Currently, this code is only for a qualitative test involving a single specimen collected via digital exam. But starting in 2008, say sources, you'll be able to use this code for one to three specimens, which could come from a digital exam or a card that the patient prepares.

• A new "unlisted antigen" code should make your immunology reports easier. A new basic metabolic panel code will make it easier to report a specific group of chemistry tests.

• You'll have a new code to report a basic metabolic panel using ionized calcium (instead of regular calcium) in 2008. Currently, if your lab performs a basic metabolic panel but measures ionized calcium (82330) instead of calcium (82310), you have to list each separate component. But starting in January, you'll report the service as 80047 (Basic metabolic panel [Calcium, ionized]).

Associations have recommended payment amounts as low as $11.83 for this code. But the Clinical Laboratory Management Association has recommended paying around $30.51, according to Katharine Ayres, director of legislative and regulatory affairs for CLMA.

• You'll also have new chemistry, microbiology and immunology codes to describe testing for antibiotic resistance, irritable bowel syndrome and adenovirus infection, among others.