Pao focus newsletter spring 2018

Pennsylvania Ophthalmology News SPRING 2018

PRESIDENT’S MESSAGE As we pull out of the depths of winter we all are lifted by the lengthening days and increased sunshine throughout this great state. The harbinger of spring gives pause to look back over the challenges and successes of the PAO in the past year. The guidance of our former president, Joanna Fisher, created important communication changes to help keep PAO members up to date on important issues. The FOCUS newsletter has been reorganized and works to keep all members aware of legislative issues, coding changes, and local insurance and reimbursement changes. We have also added a monthly electronic newsletter spearheaded by board member Scott Goldstein to help keep us informed of late breaking news that all informed ophthalmologists should be made aware of.

This last year we held a successful academic meeting in conjunction with the West Virginia state society at the Nemacolin Woodlands resort, and we will continue to look at similar meeting opportunities for the future. We also continue to hold our annual Codequest meetings, which can be invaluable training for you and your staff by helping members to avoid costly mistakes and maximize reimbursement. This year we will hold Codequest meetings April 25, 26, and 27 in the Pittsburgh, Harrisburg, and Philadelphia locations.

Pennsylvania Academy of Ophthalmology

Most recently the PAO was active in refining Senate bill SB780. This bill was championed by the Pennsylvania Medical Society (PAMED) and creates a framework allowing for insurance payment for telemedicine. It’s important to note that there was an initial attempt to exclude all eye care from this bill.

The PAO strongly opposed this since

there are many valuable ways that telemedicine can work for ophthalmology both now and in the future. The use of remote photographic ROP screening is one such example. Organized optometry then tried to prohibit online refraction by using this bill. While we share the concern for this service, the PAO took the position of the AAO, and we felt that this bill was not an appropriate place to put such restrictions.

The PAO also became alarmed and concerned on your behalf with regards to a dangerous Superior Court ruling in this state this last year. The Superior court ruling essentially concluded that inherent risks and complications of a medical procedure are irrelevant in a medical malpractice action. This makes informed consent irrelevant. It follows that, if a physician performed a procedure and followed standard of care, he or she is still responsible for a complication even though it is a known complication of the procedure and the patient was informed of this possibility. The PAO joined with PAMED in supporting an Amicus brief filed with the state Supreme Court to overturn this absurd ruling.

Looking forward, there are always new challenges in keeping ophthalmology safe for our patients and secure for our profession. But spring brings us all both a personal and professional revitalization. There are exciting new technologies and changes in ophthalmology and, like spring, these changes always keeps what we do interesting and new again.

Sincerely,

Robert L. Bergren, MD President

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

LEGISLATIVE UPDATE

The PA Academy of Ophthalmology has been informed the Senate Professional Licensure Committee plans to vote Senate Bill 668 from Committee. The bill would allow optometrists to prescribe certain schedule II drugs, order and interpret medical imaging, perform certain surgeries, identify themselves as physicians and removes the Secretary of Health from the prescribing check and balance equation.

Call your State Senator Today to oppose.

CONGRATULATIONS

TO THE 2017 PAO AWARD WINNERS

Distinguished Service Award Kenneith P. Cheng, MD

Community Service Award Michael Repka, MD, MBA

APRIL 25-27, 2018 Stay ahead of coding changes and the latest federal quality reporting requirements.

CODE

Monroeville April 25, 2018 Doubletree Hotel Pittsburgh/Monroeville Convention Center Harrisburg April 26, 2018 Pennsylvania Medical Society Philadelphia April 27, 2018 Wills Eye Institute Live Stream April 27, 2018

2018

CME/CEU is available. paeyemds.org/codequest

REGISTER AT www.paeyemds.org/codequest Registration is also available on site, but workbooks are not guaranteed.

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!

Coding Corner REIMBURSEMENT UPDATE

By:Joy Newby, LPN, CPC | Newby Consulting,Inc.

New Medicare Cards

The Medicare Access and CHIP Reauthorization Act (MACRA) requires the Centers for Medicare & Medicaid Services (CMS) to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status.

CMS has assigned all people with Medicare benefits a new, unique Medicare number, which contains a combination of numbers and uppercase letters. People with Medicare will receive a new Medicare card in the mail and will be instructed to safely and securely destroy their current Medicare card and keep their new Medicare number confidential. Issuance of the new number will not change benefits that people with Medicare receive.

CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. In June 2018, physicians will be able to look up patients’ new MBI numbers through secure web interfaces that will support quick access to the MBI. CMS plans to have a transition period where physicians can use either the HICN or the MBI to exchange data with us.

The transition period will begin no earlier than April 1, 2018 and run through December 31, 2019. Beginning in October 2018, through the transition period, when a claim is submitted using the patient’s valid and active HICN, CMS will return both the HICN and the MBI on every remittance advice. The MBI will be in the same place you currently get the “changed HICN”: 835 Loop 2100, Segment NM1 (Corrected Patient/Insured Name), Field NM109 (Identification Code). If you submit a claim using your patient’s MBI, this field will be blank.

CMS has several informational products to use to educate patients about the new card. The products are available at https://www.cms.gov/Medicare/New-Medicare-Card/Partners-and-Employers/Partners-and-employers.html.

If it is not Signed, it is not Complete

Is your documentation signed and ready for a medical record review?

Prior to submitting records to Medicare, you must ensure that the documentation is signed. For medical review purposes, Medicare requires that services provided and/or ordered are authenticated by the author. The signature must be handwritten or electronic. There are several variations of acceptable handwritten and electronic signatures that are available to physicians. A claim without a valid signature runs the risk of being denied for payment.

Do not add late signatures to the medical record, beyond the short delay that occurs during the transcription process.

If there is no signature or the signature is illegible, a signature attestation may be used if the attestation statement is signed and dated by the author of the medical record entry and contains sufficient information to identify the beneficiary.

When medical records are requested, do not send draft or preliminary copies of your records. The records need to be properly authenticated by the author, complete with a legible signature or signature attestation.

Remember, if it is not signed, it is not complete.

CPT Code** Changes for 2018

**CPT Codes and Descriptions are Copyright the American Medical Association 2017 Revised CPT Code 95930 Visual evoked potential (VEP) checkerboard or flash testing, central nervous system except glaucoma, with interpretation and report New CPT Category III Codes for 2018 0464T Visual evoked potential, testing for glaucoma, withinterpretation and report – Sunset January 2023 Describes visual evoked potential testing specifically for the detection of glaucoma, in contrast to 0333T Visual evoked potential, screening of visual acuity, automated, with report. (0333T is typically used for preschool screening.)

Clinical Example 0464T A 66-year-old female with elevated intraocular pressure and possible glaucomatous damage to the optic nerve.

0465T Suprachoroidal injection of a pharmacologic agent (does not include supply of medication) Steroid and other anti-inflammatory medications are separately reported.Typically,will be performed in the office setting.

Clinical Example 0465T A 45-year-old male with macular edema associated with noninfectious uveitis in the right eye is treated with a suprachoroidal injection of a drug into the right eye.

0472T Device evaluation, interrogation, and initial programming of intraocular retinal electrode array (e.g., retinal prosthesis), in person, with interactive adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional – Sunset January 2023 New code is different from existing code 0100T (Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy), which only includes the surgical procedure without any programming to make the system operational.

Clinical Example A 67-year-old male, blind with end-stage retinitis pigmentosa had an intraocular electrode array surgically implanted. This included placement of a subconjunctival retinal prosthesis receiver and pulse generator that requires visits with clinical staff to interrogate, evaluate and perform customized programming of the retinal prosthesis system. Visual training is provided after completion of each programming session.

0473T Device evaluation and interrogation of intraocular retinal electrode array (e.g., retinal prosthesis), in person, including programming and visual training, when performed, with review and report by a qualified health care professional – Sunset January 2023 Clinical Example A 67-year-old male, blind with end-stage retinitis pigmentosa had an intraocular electrode array surgically implanted. This involved placement of a subconjunctival retinal prosthesis receiver and pulse generator. Initial programming of the retinal prosthesis system was performed and requires subsequent reprogramming. Visual training is provided after completion of each reprogramming session.

0474T Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space – Sunset January 2023 A new drainage device is inserted into the supraciliary space via internal approach. This procedure requires development of an intraocular reservoir. When performed, this is a separate code to report in conjunction with cataract surgery.

Clinical Example 0474T A 68-year-old female with progressive visual field loss presents for surgery due to comorbid conditions of progressive cataract and open angle glaucoma, confirmed by prior optic nerve exam. The patient has consistent high measurements of intraocular pressure in spite of her pharmacologic regimen. She experiences significant disability due to visual field loss, contrast sensitivity, and diminished visual acuity which prevents her from driving and maintaining her independence. She presents for cataract surgery with a microstent implant.

This code differs from existing codes 0191T and 0376T which describe stent placement without guide wire placement or dissection in the extraocular reservoir.

0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion - Sunset January 2019 0376T each additional device insertion (List separately in addition to code for primary procedure) 0469T Retinal polarization scan, ocular screening with on-site automated results, bilateral Add-on service typically performed by pediatricians, general practitioners, and family physicians. Scan determines whether the patient passes or fails visual acuity screening. CPT instructs physicians to not report 0469T in conjunction with 92002-92014. For ocular photoscreening, see CPT codes 99174, 99177 Clinical Examples 0469T A 3-year-old child presents to the pediatrician for an annual well-child visit. The pediatrician performs a vision screening. A retinal birefringence scanning test is ordered.

A 2-year-old child presents for an examination. There is a family history of amblyopia, and the parents report possible crossing of the eyes. Ocular examination is normal, but refraction indicates the presence of borderline amblyopia risk factors. The specialist orders a retinal birefringence scanning test.

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

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