Academy requests input on coding reimbursement

May 1, 2005

You can help influence the reimbursement level for specific CPT codes by participating in the Five-Year Review of Work Values, a comprehensive review of all physician relative work values conducted by the Centers for Medicare and Medicaid Services (CMS).

You can help influence the reimbursement level for specific CPT codes by participating in the Five-Year Review of Work Values, a comprehensive review of all physician relative work values conducted by the Centers for Medicare and Medicaid Services (CMS).

The Five-Year Review presents an unprecedented opportunity to improve the accuracy of the physician work component of the resource-based relative value scale (RVS), which constitutes 53% of any code's payment. But it is also a significant challenge to the medical community-a challenge that demands your involvement, said Michael X. Repka, MD, the secretary of federal affairs of the Academy Academy of Ophthalmology (AAO).

In May, the academy will send surveys requesting information on the specific codes targeted for the Five-Year Review. The data will be used to support the argument for increasing and/or maintaining the value of these codes.

In a Five-Year Review, CMS creates a list of codes it believes are overvalued or undervalued. It also seeks input from medical specialties in identifying undervalued codes. The list is then submitted to the RVS Updating Committee (RUC), a 24-physician panel that weighs the relative value of physician work involved in these procedures.

This year, CMS identified 14 potentially overvalued ophthalmology codes for review. Among them are several high-volume ophthalmology codes: YAG capsulotomy, cataract with IOL, vitrectomy with epiretinal membrane stripping, photodynamic therapy, laser panretinal photocoagulation (PRP), fundus photography, fluorescein angiography, and visual fields. There is cause for alarm not just for the codes identified, but for all ophthalmology codes.

"If the work value and time needed to provide cataract surgery are cut, it will have a negative impact on all other ophthalmic codes because of its effect on the practice expense methodology," Dr. Repka said.

Also up for review are 15 potentially undervalued codes submitted by the academy. The academy's Health Policy Committee, with input from ophthalmic specialty societies, identified the 15 codes following a year of research.

The academy is prepared to defend the value of all 29 ophthalmic codes (14 under consideration by CMS, plus the academy's 15) before the RUC.

"But without your input, we have no defense," Dr. Repka said. "We cannot defend the cuts, and we will have no basis on which to ask for an increase. It is a data-driven, value-driven process, and it is one that works."

The job of defending the ophthalmology codes before the RUC goes to Dr. Repka, Trexler M. Topping, MD, Gregory P. Kwasny, MD, and Stephen A. Kamenetzky, MD, all of whom volunteer their time. It is a team that has an earned reputation of integrity and compiled an impressive record before the RUC, Dr. Repka added.

If you have any questions, or if you are interested in receiving a survey, contact DeChane Dorsey in the Washington, DC, office at surveys@aaodc.org
or 202/737-6662.

Don't be left out This month marks the second Eye Injury Snapshot Project, the academy's national publicity campaign to promote eye injury awareness and prevention to the public.

We need you to make the Eye Injury Snapshot Project a success. For 1 week, May 15 to 22, the academy is asking all ophthalmologists, ophthalmology residents, and emergency room physicians to report every eye injury treated. The data will provide insight into the nature and prevalence of ocular injuries, which we will then use as a foundation for a national eye injury awareness and prevention campaign targeted not only to the public, but also to the ophthalmic community.