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Third Party Newsletter (SEE PAGE SIX) MEDICARE SUPERVISION REQUIREMENTS 4

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Third Party Newsletter (SEE PAGE SIX) MEDICARE SUPERVISION REQUIREMENTS 4 March 2003 Deadline April 14, 2003 Volume 3 Issue 3 HIPAA Privacy We’re At the Finish Line... FOUND AT THE NOA 3RD PARTY WEB SITE ¨ NOA HIPAA Manual (NOA sim- plification of AOA Manual) · In Adobe PDF Format · In MS Word Format ¨ NOA HIPAA Manual Instruc- tions · In Adobe PDF Format · In MS Word Format ¨ HIPAA Signs for your office Dr. Quack is confident that you and your ¨ NOA PowerPoint Presentation staff are now prepared for HIPAA Privacy. given in February by Dr. Quack With all of the HIPAA hoopla in the last six ¨ AOA HIPAA Privacy Manual months it would be hard to be otherwise. (All 160 pages with worksheets, But, just in case you would like to review charts, and forms) our NOA HIPAA Privacy resources to confirm your preparedness, you can find ¨ Office of Civil Rights HIPAA everything you need on the special HIPAA Guidance Document (123 page of the 3rd Party section of our NOA pages) released 12/02 web site (www.noaonline.org). ¨ HIPAA Privacy Rules ASSOCIATION (Finalized) (Updated 10/02) Last Minute Questions? Dr. Quack’s ¨ Covered Entity Flow Sheet (Are query line (402-466-7470) is always open. you covered by HIPAA?) And he’ll do his best to help you cross the finish line on time! Ignore Old HIPAA “Consent” Forms “Consent” No Longer Needed to use PHI for Treatment, Payment or Health Care Operations The original 200l (now outdated) version of HIPAA final rules as published by the Bush administration privacy required each patient to sign a “consent” in October of 2002 deleted this requirement, thus form allowing the practitioner to use PHI for treat- eliminating the need to use the “consent” form. Un- ment, payment, and health care operations. If the fortunately, the form is still being advertised. Ignore patient declined to sign the consent form the practi- the form...it’s no longer needed. tioner could refuse to see the patient. However, the Inside this issue: PACHYMETRY LMRP DRAFT 2 SPECIAL NOTE: NEBRASKA OPTOMETRIC NEW BCBS POST-OP POLICY COMING UP 3 Þ DMERC MANUAL NOW ONLY AVAILABLE ON-LINE MEDICARE REIMBURSEMENT FOR JAN—FEB 2003 3 Third Party Newsletter (SEE PAGE SIX) MEDICARE SUPERVISION REQUIREMENTS 4 EXTENDED OPHTHALMOSCOPY 5 March 2003 Good News : Medicare Drafts LMRP for Pachymetry You will be pleased to find pachymetry listed at the Medi- other plastic surgery for unacceptable cosmetic appearance, plus the care website under draft LMRPs (Local Medical Review modifier GY. In the case of a statutorily excluded service, the Medicare Policies). Despite significant restrictions for reimbursement limiting charge does not apply. (of about $84 per patient), the LMRP is a positive step in Modifier KX may be used with code 0025T when the provider believes patient care when considering the results of the Ocular Hy- additional information might result in payment for the service under pertension Study. The Draft LMRP can be found at: circumstances in which it would usually be denied. An example HTTP://WWW.KANSASMEDICARE.COM/PART_B/LMRP/DRAFTS/BDRAFT_PACHYMETRY_CORNEA.HTM would be an ophthalmologist or optometrist who examines a patient who previously has been cared for by another eye care provider. The patient Some highly abbreviated excerpts from the Draft follow. states they have glaucoma, they have had corneal pachymetry, and they are taking eye drops to treat glaucoma. The second ophthalmologist or Indications and Limitations optometrist questions the diagnosis of glaucoma. They make a reason- Corneal thickness measured by corneal pachymetry affects clinical able effort to obtain the existing pachymetry record from the former oph- decisions or diagnostic tests in the following: thalmologist or optometrist. However, they do not receive the measure- · measurement of intraocular pressure; ment. The second ophthalmologist or optometrist documents this in the · measurement of physiologic function of corneal endothelial patient’s record, performs the diagnostic test and bills for the service with cells; the KX modifier attached. A second example might be when corneal · measurement of corneal thickness in preparation for refrac- pachymetry is performed in order to aid in determining if a penetrating tive surgery. keratoplasty is indicated. If it has been less than one year since a previ- Code 0025T will be considered bilateral and assigned the same relative ous corneal pachymetry CPT level III code 0025T may be billed with the value units (RVUs) as code 76516 ophthalmic biometry by ultrasound. modifier KX. [Ed. Note: about $84 in NE]. When corneal pachymetry is allowed once per year begin counting the Corneal pachymetry will always be denied when it is used in clinical month following the previous corneal pachymetry. Eleven months after decision-making associated with refractive surgery. Refractive surgery the month following the prior corneal pachymetry, another corneal pachy- is a statutorily excluded service [Social Security Act 1861a7-Cosmetic metry will be allowed. surgery]. ICD-9 CODES THAT SUPPORT MEDICAL NECESSITY When there is not a scientifically demonstrated effect upon medical management of a disease, corneal pachymetry will be denied. For ex- 364.53 PIGMENTARY IRIS DEGENERATION ample, when the diagnosis of glaucoma has been established, corneal 364.77 RECESSION OF CHAMBER ANGLE 365.00 BORDERLINE GLAUCOMA [GLAUCOMA SUSPECT]; PREGLAUCOMA, UNSPECI- pachymetry will not add medically necessary information to the clinical FIED management decisions. A second example is prior to cataract surgery 365.01 BORDERLINE GLAUCOMA [GLAUCOMA SUSPECT]; OPEN ANGLE WITH BOR- DERLINE FINDINGS there is no proof measuring endothelial cell number or function, i.e., 365.02 BORDERLINE GLAUCOMA [GLAUCOMA SUSPECT]; ANATOMICAL NARROW corneal pachymetry improves patient outcome by influencing the type ANGLE of cataract surgery technique, extracapular expression or phacoemulsi- 365.03 BORDERLINE GLAUCOMA [GLAUCOMA SUSPECT]; STEROID RESPONDERS 365.04 BORDERLINE GLAUCOMA [GLAUCOMA SUSPECT]; OCULAR HYPERTENSION fication. Corneal clarity and endothelial cell function over the long-term 366.11 PSEUDOEXFOLIATION OF LENS CAPSULE is the same following either technique. The corneal pachymetry is not 371.20 CORNEAL EDEMA, UNSPECIFIED medically necessary to make a clinical decision. However, if there was 371.21 IDIOPATHIC CORNEAL EDEMA 371.22 SECONDARY CORNEAL EDEMA evidence of corneal endothelial dysfunction prior to cataract surgery 371.23 BULLOUS KERATOPATHY and the purpose of corneal pachymetry was to aid in the decision 371.57 ENDOTHELIAL CORNEAL DYSTROPHY COVERAGE IS FURTHER RESTRICTED TO ONLY FUCH’S ENDOTHELIAL DYSTROPHY WITHIN THIS DIAGNOSIS CODE. whether to perform a combined corneal transplant plus cataract surgery 371.58 OTHER POSTERIOR CORNEAL DYSTROPHIES or cataract surgery alone, corneal pachymetry may be medically neces- 996.51 MECHANICAL COMPLICATIONS OF OTHER SPECIFIED PROSTHETIC DEVICE, IMPLANT, AND GRAFT; DUE TO CORNEAL GRAFT sary. Coding Guidelines Correct Procedural Terminology Code Level III 0025T “Corneal Pachymetry” will be assigned the same relative value units (RVUs) as procedure code 76516, ophthalmic biometry by ultrasound. Corneal pachymetry code 0025T will be considered a bilateral service. One unit Documentation of service will be paid for measurement on either both eyes or one eye. Requirements Modifier GZ should be used with code 0025T when the provider be- lieves the service will be denied due to [lack of] medical necessity. The medical record must An example would be if the provider wished to measure corneal thick- contain a specific reference ness in a patient with a diagnosis of glaucoma. In this case, corneal to the corneal pachymetry pachymetry would not be medically necessary to make a decision to measurement and this treat glaucoma. measurement’s effect upon the clinical decision-making Modifier GY should be used with code 0025T when the provider be- process. This is the interpre- lieves the service will not be paid because of statutory exclusion. An tation of the report. example would be corneal pachymetry performed in preparation for refractive surgery. This may be submitted using ICD-9 code V50.1, Page 2 March 2003 THIRD PARTY NEWSLETTER More Good News : BCBS Drafts New Pre- & Post-op Care Policy The following information sure accurate usage of the above modifiers. regarding post-op coding was included in the Febru- For claims processed ary 2003 issue of the Blue on and after May 1, 2003 Cross—Blue Shield Update BCBSNE will discontinue the 3 days prior/14 days after pre- newsletter. and post-operative global period; and instead, implement a BCBSNE announced global surgical period similar to CMS. Refer to your CPT Sur- adoption of a pre-operative gery Guidelines Chart to determine which surgical procedures and post-operative medical include pre- and post-operative care. Note: These changes apply to all lines of business. All surgical procedures policy similar to Centers for must be billed prior to the post-operative services or Medicare and Medicaid along with the post-operative services. In the event an- Services (CMS). This other surgical procedure is performed during the post- change involves two operative period of an initial procedure, a new post- phases. operative period will apply. When Itinerant surgery is in- volved, BCBSNE will continue to reimburse the surgeon the Beginning with claims processed lesser of the surgeon’s charge or 90 percent of the negotiated on and after February 1, 2003 fee schedule. The assistant surgeon, when applicable, will continue to receive the lesser of his/her charge or 20 percent BCBSNE will recognize and separately reimburse for of the negotiated fee schedule and may also be reimbursed Evaluation and Management (E&M) services performed the lesser of their charge or 10 percent of the negotiated rate within the pre-operative and/or post-operative period when for all uncomplicated pre- and post operative care. billed appropriately with the following modifier(s): -24 Indicates than an unrelated E&M service was per- BCBSNE will honor this arrangement as long as the appropri- formed by the same physician during a post-operative ate modifiers are utilized (-54, -55 & -56).
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