CMS corrects error in retina detachment code

March 4, 2008

San Francisco-The Centers for Medicare and Medicaid Services has issued an emergency notice to correct a typographical error in the relative value unit of the new Current Procedural Terminology code for complex retina detachment, said the American Academy of Ophthalmology (AAO) in a notice to members.

San Francisco-The Centers for Medicare and Medicaid Services has issued an emergency notice to correct a typographical error in the relative value unit of the new Current Procedural Terminology code for complex retina detachment, said the American Academy of Ophthalmology (AAO) in a notice to members.

The mistake related to code 67113 created a rank order anomaly with other retinal codes and a significant decrease for complex retinal detachment repair, according to the AAO, which recommended that ophthalmologists review any billings that contain this code and discuss with their insurance carriers how additional funds, based on the corrected code, will be transmitted to their offices.

The organization expressed dissatisfaction with the adjustment to the work value made for the complex retina detachment code last year by the Relative Value Scale Update Committee (RUC). The work value decreased from 34.55 to 25.0 based on the survey responses of 34 vitreoretinal surgeons (out of 138 solicitations), which indicated a median intraservice time of 130 minutes, down from 277 minutes in 1989.

A higher response rate from retina specialists to the next survey could affect the work value positivity, the AAO said.

“Both the [AAO] and the retinal specialty societies have tried to protect the value of this very challenging procedure. Unfortunately, prior imprecise coding raised the issue of the proper identification and payment of complex detachments, and new vitrectomy technology with shorter times in the operating room lowered the valuation,” wrote William L. Rich II, MD, AAO medical director of health policy, and George A. Williams, MD, RUC alternate member and AAO Health Policy Committee member. “The value remains higher than any other ophthalmic service, but that is little consolation to those who provide care to [patients with this condition]. A chance for appeal in 5 years is possible if we can demonstrate a [population with a more difficult condition] than was used in the current survey.”