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    2015 brings big Medicare changes, small technology changes to glaucoma surgery


    Codes reviewed

    The change affected Current Procedural Terminology (CPT) codes 66179, 66180, 66184, and 66185 in 2015.

    When the codes came up for review, CMS discovered that surgeons typically bill for the two procedures together and ruled that they were really one procedure. (Some surgeons place aqueous shunts without grafts, and now can use code 66179 for an aqueous shunt without patch graft or 66184 for an aqueous revision without a patch graft.)

    In the meantime, CMS announced in November 2015 that it is planning to close a temporary loophole that allowed facilities to maintain their 2014 level of reimbursement by invoicing separately for cornea tissue used as patch grafts. The loophole was brokered by the AGS and AAO.

    The cut may force many surgeons in 2016 to do their shunt procedures in hospitals where facility reimbursements are higher and more easily cover the costs of all the bundled supplies rather than in ambulatory surgery centers. If very many make that change, CMS will end up paying more than if it had not made the cut, said Dr. Mattox, and patients will face higher co-payments and may have access problems.

    Also in November, CMS announced that it was applying its budgetary axe to trabeculectomy. The Relative Value Scale Update Committee (RUC) had not reviewed trabeculectomy reimbursement for many years, and determined that surgeons have trimmed about 15 minutes off of intraoperative time.

    CMS has issued the final rule cutting reimbursement by 19% for each trabeculectomy code in 2016, In 2017 the cuts would reach a total of 25% for code 66170, 30% for code 66172 and 35% for code 65855.

    The procedures are the bread and butter of glaucoma surgery, Dr Mattox said. “We’re talking about what we do for the most severe cases who present to specialists. IThese procedures are almost always performed in patients who have no other choice. If we don’t do something they will go blind.”

    The cuts could spur some surgeons to retire early and deter others from entering the field, creating a shortage of specialists able to do this work, Dr Mattox warns.

    She and along with members of the AGS and AAO are continuing to resist. They plan to argue that CMS ignored the recommendation of the RUC, which is tasked with determining reasonable reimbursement for medical procedures. The RUC advised a 7% cut.

    But CMS has the final word, and it is faced with a mandate from Congress to trim its total outlay forphysician reimbursements for each year in 2016, 2017 and 2018 while increasing reimbursement for primary care. “Other specialties besides ophthalmology, such as cardiology and radiology have been hit pretty hard in the last few years and they have not been successful in reversing these types of cuts,” Dr Mattox said.

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