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Coding Update for Medicare 2009 A Happy New Year to all! We do not have as many CPT code changes as last year but there are a lot of ICD-9 codes, especially for neurological diseases. As well, new Category III codes become effective every six months. Highlights of the changes follow. NEW CPT (Current Procedural Terminology) Codes There is a new code for endothelial keratoplasty as well as for preparation. The preparation code is an add-on code which means you will be paid the full allowable on this code. As well, there have been editorial revisions to accompany the new codes. The keratoplasty codes now read as follows with * indicating a code description change and M indicating a new code. Corneal transplant includes use of fresh or preserved grafts. The preparation of donor material is included for penetrating or anterior lamellar keratoplasty, but reported separately for endothelial keratoplasty. Do not report 65710-65757 in conjunctions with 92025. * 65710 Keratoplasty (corneal transplant);anterior lamellar Note that CMS has decided to have CPT code 65757 priced by your local Medicare contactor and not on a national basis. DELETED CPT CODES Modifier 21 has been deleted and the prolonged services codes have been revised. CATEGORY III (EMERGING TECHNOLOGY) CODES The Category III codes are actually updated every 6 months and can be accessed online at the ;AMA website www.ama.assn.org This is somewhat confusing due to the vagaries of the system. The implementation date occurs 6 months after the release follows this format: (Release date Implementation date CPT book). You may begin using the code on the implementation date even though it does not appear in that years CPT. * 0124T Conjunctival incision with posterior extrascleral placement of pharmacological agent (does not include supply of medication) For suprachoroidal delivery of pharmacologic agent us 0186T M 0186T Suprachoroidal delivery of pharmacologic agent (does not include supply of medication) (07.01.2007 01.01.2008 CPT 2009) M 0187T Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral (07.01.2007 01.01.2008 CPT 2009) 0198T Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report (07.01.2008 01.01.2009 CPT 2010) Category I Revisions See keratoplasty codes above ICD-9 CODES in 2008/2009 The following are some of the more important ICD-9 codes that went into effect October 1, 2008 for 2009. You are advised to check the comprehensive listings in the new ICD-9. ICD-9 Changes Effective October 1, 2008 249.5 *Secondary diabetes mellitus with ophthalmic manifestations Check in your new ICD 9 for the many new codes for headaches and migraines Published in EyeWorld January 2009 Administrator's
Notes CMS E-prescribing Rule Medicare will provide incentive bonus payments to physicians providing covered services to Medicare beneficiaries who successfully use electronic prescribing for their patients. The incentive payment is 2% for 2009 and 2010, 1% for 2011 and 2012 and .5% for 2013. If eligible physicians do not e-prescribe, penalties of -1% in 2012, -1.5% in 2013 and -2% in 2014 and beyond will be imposed. Reporting on the use of e-Rx will be through the PQRI program. The incentive and penalties percentages will be calculated payments made for all Medicare reimbursable services. Further information about the incentive program will be provided by CMS in the fall of 2008. Providers with low volume or no internet connectivity may be excluded from the program. E-prescribing can be accomplished through an EMR or with a stand alone e-Rx system. A coalition of
vendors offers free e-prescribing software at www.nationalerx.com.
Other vendors are available. E-Rx standards have been established by CMS. They include the ability to send electronic transactions for new prescriptions, refill requests and responses, prescription change or cancellation requests and responses and related messaging and administrative transactions. Eligibility and benefits queries and responses between prescribers, dispensers and part D sponsors are part of the standard. Additional standards include the ability to provide the following information: formulary and benefits, medication history, fill status notification and identification of individual healthcare providers. Information about e-prescribing is available at: www.cms.hhs.gov/eprescribing and www.ascrs.org/e-rx 2007 PQRI RESULTS Physicians who participated in the PQRI incentive program in 2007 received their incentive payments in late July. Only 50% of providers who successfully submitted PQRI codes were eligible for the incentive bonus. To get information about the 2007 results and how payments were tabulated you must access the new CMS web portal, IACS. You must register for access to the site at www.cms.hhs.gov/IACS. Click on provider/supplier community and download the instructions for each type of registration. You NEED the instructions. The registration process is very complicated and time consuming. If you are registering for information about a group practice, the group must be registered by a security officer who will designate a User Group Administrator. These two roles cannot be filled by the same person. The security officer does not have access to information. The Group Administrator will register all authorized users for the group. Solo practitioners register with only one person but no one else can get access to information for that type of provider. In the future this web portal will be used for provider enrollment and statistical and reimbursement reports. Additional applications will be announced in the future. |
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