Ophthalmology and Optometry Coding Alert

It's not all bad news: Your reimbursement for eye exams and E/M services should rise -- slightly.If your practice uses indocyanine-green (ICG) angiography to enhance imaging of the eye's blood vessels, get ready for a nearly 10 percent reimbursement reduction in 2009, resulting in almost $24 less pay.That's one thing experts discovered when the Centers for Medicare & Medicaid Services released its final version of next year's Physician Fee Schedule. A lower conversion factor, combined with a reduction of the relative value units (RVUs) assigned to the technical component (TC) of certain diagnostic imaging procedures, will result in a national average reimbursement of only $216.40 (without geographical adjustments) for 92240 (Indocyanine-green angiography [includes multiframe imaging] with interpretation and report) -- a 9.96 percent drop from 2008's $240.33.Technical Payment Falls While Professional Payment Rises SlightlyGood news: But if your ophthalmologist only performs the professional component of 92240, you may see a small increase. The RVUs assigned to 92240-26 (Professional component) are staying put at 1.58 in 2009 -- and although the conversion factor is slipping from 38.0870 to 36.0666, in 2009, CMS will no longer apply a budget neutrality adjuster (BNA) to a procedure's work RVUs. Result: A 92240-26 claim should bring in $56.99 in 2009, compared with $55.23 in 2008."There is a 6.5-percent, five-year practice expense reduction that has been in the works for the past five years, so without the 1.1 percent increase, we would be seeing a 6.5 percent overall decrease in reimbursement," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions. "Instead, we are now seeing a 5.4 percent decrease."Bad news: The loss in payment for the technical component of 92240 will more than offset the gain in the professional component. In 2009, 92240-TC only has 4.42 RVUs, compared with 4.86 in 2008. This brings the national payment for 92240-TC down to $159.41 from last year's $185.10. Add $159.41 to the $56.99 payment for 92240-26 to arrive at the new global fee: $216.40.Background: "The current five year review [of Medicare payments] focuses only on the physician work component of specific procedures," explains Maggie M. Mac, CMM, CPC, CPC-E/M, ICCE, consulting manager for Pershing, Yoakley, and Associates in Clearwater, Fla. "However, future reviews will include the practice expense (technical component) when the resource-based values are established in the Medicare Fee Schedule. In other words, there are no work RVUs associated with the technical component of a procedure."Brace for Ophthalmic Ultrasound LossesThe ongoing reduction in TC payments will also affect your reimbursements for A- and B-scans:•76510 (Ophthalmic ultrasound, diagnostic; B-scan and quantitative A-scan performed during the same patient encounter) ��" $147.15 in 2009 ($5.58 reduction from 2008)•76511 (... quantitative A-scan only) -- $96.30 in 2009 ($11.11 [...]