EyeNet Magazine


 
Savvy Coder: Coding & Reimbursement
Multiple Testing Services—Test Yourself on This Year’s Changes
By Sue Vicchrilli, COT, OCS, Academy Coding Executive
 
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(PDF 82 KB)

This year, CMS announced a multiple procedure payment reduction (MPPR) that impacts 27 ophthalmic testing codes. It affects payment for those codes’ technical component (–TC), which represents performance of the test, equipment used, and cost of supplies.

How does the MPPR work? When multiple tests from the list of affected codes (see "27 Testing Codes Affected") are performed on the same patient on the same date of service, the test with the highest –TC value is reimbursed in full, but payment for the –TC of the second and subsequent tests is reduced by 20 percent. The reduction is calculated automatically, regardless of whether you appended the –TC and –26 modifiers.

What’s the Payment? 

Use these six scenarios to test your awareness of MPPR’s impact on your practice. When the following services are performed on the same day on the same patient, do you know which would be reimbursed in full and which would be hit by the 20 percent reduction to –TC reimbursement?

Q1. Exam and visual field (VF).

a) 100 percent for exam and VF. 

b) 100 percent for exam; –TC reduction for VF.

Q2. Exam, OCT, and subsequent ophthalmoscopy (SO) on the right eye.

a) 100 percent for exam and SO; –TC reduction for OCT. 

b) 100 percent for exam, OCT, and SO.

Q3. Exam, SCODI, VF, and pachymetry.

a) 100 percent for exam, VF, and SCODI; –TC reduction for pachymetry. 

b) 100 percent for exam and VF; –TC reduction for SCODI and pachymetry.

Q4. Exam, fluorescein angiography (FA), and fundus photography. Pathology is in both eyes.

a) 100 percent for exam and FA of one eye; –TC reduction for FA of second eye and fundus photography. 

b) 100 percent for exam and FA of both eyes; –TC reduction for fundus photography.

Q5. VF (92083) and fundus photography.

a) 100 percent for fundus photography; –TC reduction for VF. 

b) 100 percent for VF; –TC reduction for fundus photography.

Q6. Exam, VF (92081), and external ocular photography.

a) 100 percent for exam and VF; –TC reduction for ocular photography. 

b) 100 percent for exam and ocular photography; –TC reduction for VF.

___________________________

Answers: Q1—a; Q2—b; Q3—b; Q4—a; Q5—a; Q6—a or b (same –TC for VF and photo). 

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27 Testing Codes Affected

The MPPR applies to 27 ophthalmic testing codes:

76510 Ultrasound

76511 Ultrasound, A-scan only

76512 Ultrasound, diagnostic; B-scan

76513 Anterior segment ultrasound

76514 Pachymetry

76516 Biometry

76519 A-scan

92025 Topography

92060 Sensorimotor exam

92081 Visual field

92082 Visual field, intermediate examination

92083 Visual field, extended examination

92132 Anterior segment SCODI

92133 SCODI

92134 OCT

92136 A-scan

92228 Remote imaging

92235 Fluorescein angiography

92240 ICG

92250 Fundus photo

92265 Needle oculoelectromyography

92270 Electro-oculography

92275 Electroretinography

92283 Color vision

92284 Dark adaptation

92285 External ocular photography

92286 Special anterior segment photography

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