You have a new payment opportunity in 2016 if you’re an eye doctor, but it’s not all good news – a number of codes involving retinal surgery will see significant pay cuts Jan 1.
The good news first: Eye docs can bill for corneal surgery using code 65785 (Implantation of intrastromal corneal ring segments) in 2016, notes Michael Repka, M.D., CPT advisor committee member at the AMA’s 2015 CPT® and RBRVS Annual Symposium in Chicago. He describes a typical patient as one with progressive keratoconus in both eyes.
The driving reason behind the pay cuts involving four retinal-detachment codes is a downward shift in the codes’ relative value units (RVUs), which factor into total payment rates, notes Repka.
“Retinal surgeons are unhappy right now,” says Repka. The involved codes, all of which will see lower payment on Jan. 1, are listed below:
- 67107 (Repair of retinal detachment; scleral buckling [such as lamellar scleraldissection, imbrication or encircling procedure], with or without implant, with or without cryotherapy, photocoagulation, and drainage of subretinalfluid)
- 67108 (Repair of retinal detachment; with vitrectomy, any method, with or without air or gas tamponade, focal endolaser photocoagulation, cryotherapy,drainage of subretinal fluid, scleral buckling, and/or removal of lens by same technique)
- 67110 (Repair of retinal detachment; by injection of air or other gas [eg,pneumatic retinopexy])
- 67113 (Repair of complex retinal detachment [e.g., proliferative vitreoretinopathy,stage C-1 or greater, diabetic traction retinal detachment, retinopathy ofprematurity, retinal tear of greater than 90 degrees], with vitrectomy and membrane peeling, may include air, gas, or silicone oil tamponade, cryotherapy, endolaser photocoagulation, drainage of subretinal fluid, scleral buckling, and/or removal of lens)