Optometry Coding & Billing Alert

Published on Thu Oct 08, 2009 PDF

You'll also see $14 less for some established patient E/Ms.

A quick glance at the proposed 2010 fee schedule shows increased relative value units (RVUs) for several optometry procedures. Great news, right? Not so fast: Once you take the proposed cuts to the conversion factor into account, the future's not so bright.

Example: In 2009, 92012 (Ophthalmological services: medical examination and evaluation, with initiation and continuation of diagnostic and treatment program; intermediate, established patient) has 1.96 total non-facility RVUs. In 2010, Medicare proposes to give the same procedure 2.07 RVUs. However, Medicare multiplies the RVUs by a conversion factor to arrive at the total reimbursement, and in 2010 the conversion factor may drop from $36.0666 to $28.4061. This will lead to a drop in reimbursement for 66984 from $70.69 (1.96 x $36.0666) to $58.80 (2.07 x $28.4061).

For more information on the conversion factor change, see "Fee Schedule Cuts Medicare Pay by 21.2%, Scraps Consults" on page 81. Read below to see how the proposed fee schedule changes will affect some common eye exam and E/M procedures in 2010.

Source: Table 50, "Impact of the Final Rule With Comment Period and Estimated Physician Update on 2010 Payment for Selected Procedures," from "Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2010" at www.federalregister.gov/OFRUpload/OFRData/2009-26502_PI.pdf.