Focus Spring 2017

Pennsylvania Ophthalmology News SPRING 2017

PRESIDENT’S MESSAGE By: Joanna M. Fisher, MD

Even after a relatively mild Pennsylvania winter, most of us are eagerly awaiting spring and the feeling of renewal that happens as the weather warms and the flowers bloom. During this season of revitalization, it only seems fitting that the spring issue of our newsletter showcases our brand-new look. In addition to the new design, you’ll find the content of this newsletter to be more encompassing than in the past. Be sure to check out our new coding corner for the latest coding guidelines, what’s on the legislative horizon with an update from Milliron & Goodman, and upcoming events with the PAO. As part of our strategic plan, we kicked off this year with a new monthly e-communication, inSight, which launched in January. Be sure to keep an eye on your inbox each month for the latest updates on legislative, billing, and PAO happenings. A special thank you to Scott Goldstein for organizing this initiative and to our members who have provided content for these timely updates. We hope that inSight achieves our goal of provide members with relevant communications.

Pennsylvania Academy of Ophthalmology

This season of new beginnings with the PAO wouldn’t be possible without the work of our administrative staff, who works behind the scenes to keep our organization thriving. The PAO staff has spent a tremendous amount of time working on updating our communications, planning and coordinating events, brainstorming new member benefits and recruitment projects, and working with Milliron &

Goodman on advocacy initiatives. I would like to take a moment to thank Jennifer Keeler, Executive Director; Kim Whetsell, Assistant Executive Director; Melanie Dupont, Member Service Specialist; and Judy Clapp, Meeting Manager; for all that they do.

The PAO would not be able to exist without the hard work of this team.

All good communication requires a two-way street. Please continue to provide us with feedback on topics and activities that will benefit you in your practice. Email the PAO executive office at pao@pamedsoc.org with any suggestions.

Spring is also a busy time for the PAO as we prepare for a variety of member events. We hope that you and your administrative staff enjoyed this year’s Codequest, which took place in Pittsburgh, Harrisburg, and Philadelphia in mid-March. Additionally, our joint meeting with West Virginia Academy of Eye Physicians and Surgeons at Nemacolin Woodlands Resort is coming up on April 28-30.

This is our first venture into clinical education in more than a decade and the agenda is chocked-full with a variety of great topics and speakers.

Finally, we will also be hosting Advocacy Day on May 22. I urge you to register for this event and help make sure our voice is heard in Harrisburg.

Here’s to rejuvenated PAO communications and an eventful spring. We look forward to seeing and hearing from you.

PENNSYLVANIA ACADEMY OF OPHTHALMOLOGY | 777 East Park Drive, PO Box 8820 | Harrisburg, PA 17105-8820 Phone: (717) 558-7750, ext. 1518 | Fax: (717) 558-7841 | Email: pao@pamedsoc.org | www.paeyemds.org

Coding Corner CODING AND COMPLIANCE By:Joy Newby, LPN, CPC | Newby Consulting,Inc.

Denials for Second Eye A-Scans and Ophthalmic Biometry

The Centers for Medicare & Medicaid Services (CMS) changed the bilateral indicators for the professional components of a-scans (76519-26) and ophthalmic biometry (92136-26) on the Medicare Physician Fee Schedule Data Base (MPFSDB) effective with dates of service on or after January 1, 2017. Historically, the bilateral indicators for bilateral services allowed for unilateral reporting of the professional component.

The bilateral indicators assigned to the global service (76519/92136) and technical component (76519-TC and 92136-TC) were not changed. The relative value units (RVUs) for these codes represent bilateral services, which means the payment for these codes is for bilateral services.

Physicians should note that when the global and technical component is performed unilaterally, a -52 modifier should be appended to the code to indicate the test was performed unilaterally. In the narrative section, indicate the test was performed unilaterally.

Novitas Modifier 52 and 53 Fact Sheet - Not all inclusive Modifier 52 Under certain circumstances a service or procedure is partially reduced or eliminated at the provider’s discretion.

Example: Unilateral mammogram on right breast due to left breast mastectomy.

Supporting Documentation Additional information to support modifier can be written in narrative of claim The professional component (interpretation and report) has always been a unilateral service, meaning this component could be reported for each eye tested. Novitas Coding Article number A53131, Ophthalmic Biometry for Intraocular Lens (IOL) Power Calculation provides the following instructions for reporting 76519-26 and 9213626 (Not All Inclusive) Coding Guidelines CPT codes 76519 (A-scan with IOL power calculation) and 92136 (Biometry by Partial Coherence Interferometry with IOL power calculation) have a bilateral technical component and a unilateral professional component. The professional component is normally done only for the eye for which surgery is planned.

Therefore, when either 76519 or 92136 is reported, the reimbursement includes payment for both eyes for the technical component and one eye for the professional component. In this scenario, report 76519 or 92136 and indicate for which eye the professional component was performed (e.g., 76519 RT).

Commonly, when a patient is diagnosed with bilateral cataracts, the surgeries are performed weeks apart.

In this instance, an IOL power calculation is necessary prior to the second surgery. However, the technical portion of the test is not warranted again. In this scenario, it is necessary to indicate that only the professional component is being reported by appending the professional component “modifier 26” and identifying for which eye the calculation is being made, (e.g., 76519 LT-26 or 92136 RT-26).

It is not appropriate for one physician/provider (physician “A”) to bill for the global service, and then another physician/provider (physician “B”) to bill for a re-read (professional component) of the same study.

Cataract surgery should usually not be performed on both eyes on the same day, unless special circumstances exist (e.g., high risk for anesthesia, etc.). In situations when these circumstances do exist, it would be necessary for the IOL power calculation to be performed bilaterally. In this scenario, it is necessary to indicate that the technical and professional components are being reported for both eyes (76519-26-50 and 76519-TC or 92136-26-50 and 92136-TC).

Below are examples of appropriate coding for 76519 and 92136: • Test is performed on both eyes (TC) but calculation is performed on left eye only. Report: 76519-LT or 92136-LT • Test is performed on both eyes (TC) but calculation is performed on right eye only. Report: 76519-RT or 92136-RT

Congratulations TO THE FOLLOWING

• Test is performed on both eyes (TC) and calculation is performed on both eyes on the same day. Report: 76519-TC and 76519-26-50 or 92136-TC and 92136-26-50 • Today, only the IOL power calculation is performed on the left eye (the IOL power calculation on the right eye and the technical component for both eyes was performed 3 weeks ago). Report: 76519-LT-26 or 92136-LT-26

2016 PAO AWARD WINNERS

Current Issue - Denials for the 2nd Eye

As noted above, CMS changed the bilateral indicators for 76519-26 and 92136-26 from “3” to “2.” This means claims for the interpretation and report of the 2nd eye are being denied for frequency.

Shortly after the problem was discovered, the AAO requested CMS correct the error. On February 22, 2017, CMS released the changes to the MPFSDB effective with dates of service on or after April 3, 2017. The update resolves the problems billing the professional component for the 2nd eye a-scan/OCB.

Humanitarian Service Award David Silbert, MD, FAAP

Claims for bilateral 76519-26 and 92136-26 for the 2nd eye will continue to deny/reject until April 3, 2017. In the interim, ophthalmologists have options: • Continue billing the 2nd eye which will result in a denial/ rejection - On April 3, 2017 if the claim for 76519-26 or 92136-26 • denied with remark code MA01 - request Novitas reopen the denied claims • rejected with remark code MA130 - send a new claim to the MAC for each rejected claim • Hold claims for the 2nd eye until April 3, 2017 and send all held claims to the MAC Physicians do not have to complete a reopening request for each denied claim. Create a spreadsheet with the following columns: • Beneficiary’s first name • Beneficiary’s last name • Beneficiary’s Medicare number • Claim number for denied 76519-26 or 92136-26 • Date of service • Procedure code with modifier ***Be sure to include the name, address, and NPI for the practice in the header.

Complete all fields on the Medicare Part B Redetermination and Clerical Error Reopening Request Form For the above fields, insert “see spreadsheet.” The form is available on the Novitas website at http://www.novitas-solutions. com/webcenter/content/conn/UCM_Repository/uuid/ dDocName:00008291. In the Reason for Redetermination or Clerical Error Reopening Request field, enter your reason for requesting the reopening. No specific language is required, simply state the reopening request for the claims identified on the following spreadsheet is due to a change from a bilateral to a unilateral service per MLN Matters article MM9977. Fax the form and spreadsheet to Novitas at 1-888-541-3829.

Distinguished Service Award Solomon Luo, MD, FACS

Community Service Award Senator Richard Alloway, II

LEGISLATIVE UPDATE By: Andy Goodman | Milliron & Goodman Government Relations Here we go again! The beginning of the two-year legislative cycle started January 1, 2017 and will end November 30, 2018. Over the coming months, I fully expect the Academy to be engaged in advocacy on a few key issues. I know sometimes the issues seem to last forever, but I urge you to remain persistent. The Pennsylvania General Assembly has changed dramatically over the past ten years. There is a super majority of Republicans and a Democratic Governor during this two-year cycle.

That political environment must deal will a 1.7 billion budget deficit first, and then it will begin looking at outlying issues. That is a difficult responsibility, but I bring it to your attention because a great deal of the

General Assembly’s time is being spent on the budget. Nevertheless, our Academy continues to press for a definition of ophthalmic surgery and will be advocating for pediatric screening legislation. The definition of ophthalmic surgery is being introduced, again, by Senators David Argall and Rich Alloway. I urge you to make a call to your Senator supporting the definition of ophthalmic surgery legislation. Also, do the same with your House member when the pediatric screening legislation is introduced. The Academy will make you aware when it is in bill format in the House of Representatives.

Persistence is what will get our patient protection issues across the finish line.

On the flip side, organized optometry has been working with the Senate to introduce legislation that would significantly expand the scope of practice of optometrists. Certainly, there are significant patient safety issues that our Academy recognized in last session’s legislation. The newest bill, I suspect, will closely resemble their last attempt. We will continue to advocate for patient safety and quality of care.

Finally, once again, I urge you to call and meet with your local Senator and House of Representatives member.

Take it a step further, invite them to your surgical suite or office. Personal relationships are critical to your patients’ safety and practice. Stay engaged.

2017 Annual Scientific Meeting

April 28-30, 2017 NEMACOLIN WOODLANDS RESORT HOSTED BY

Covering Topics Such As: Glaucoma Femto Laser – Pros & Cons Unusual Case Studies MACRA

CME will be available *pending appropriate approval

Alternative Payment Methods Unvetis Cornea

For more information and to register, go to: www.paeyemds.org or www.wvaeps.org

Ensure Your Voice is Heard in Harrisburg Join the PAO for Advocacy Day May 22, 2017

HARRISBURG, PA Details and Registration at www.paeyemds.org

It’s not a puzzle, only ophthalmologists should perform eye surgery.

Please contribute to the PAC. The PA Ophthalmology PAC needs funds to protect safe eye surgery.

You can donate online today at www.paeyemds.org or call the PAO at (717) 558-7750 ext. 1518.

Please help your profession and contribute today!

PRSRTD STD U.S. POSTAGE PAID HARRISBURG PA PERMIT NO. 922

Pennsylvania Academy of Ophthalmology 777 East Park Drive PO Box 8820 Harrisburg, PA 17105-8820

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