Another year has passed, and what a year it’s been. Looking back, 2010 was a little like a wedding—something old, something new, something borrowed and something blue.

Something Old
The passage of the Patient Protection and Affordable Health Care Act earlier this year has certainly changed the playing field for all medical providers in the U.S. Leaders in our field who were involved in this process worked diligently and successfully in many areas to protect our ability to be the primary/secondary eye care providers, while paving the pathways to increase our access to both managed care plans and patients.

Something New
Since we’re about to begin a new year, new CPT changes are coming fast and furious. The most important of these are the changes to scanning laser ophthalmoscopy. Here is a summary of those changes—be aware that not only has the code changed, but also the definition and application as well.

• 92135. Eliminated as of January 1, 2010
• 92132. Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral or bilateral (replaces HCPCS Level III 0187T).
• 92133. Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve.
• 92134. Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina.

Be aware that the CPT specifically states that 92133 and 92134 cannot be performed on the same date of service. All of these services are to be reported with units of 1 and a single charge whether done on one eye or both.

Additional changes to the ophthalmoscopy codes have also been revised to include the following:
• 92227. Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral.
• 92228. Remote imaging for monitoring and management of active retinal disease (e.g., diabetic retinopathy) with physician review, interpretation and report, unilateral or bilateral.

Something Borrowed
On November 29, Congress approved the Physician Payment and Therapy Relief Act of 2010, temporarily averting a 23% cut in Medicare physician pay that had been scheduled to go into effect December 1, 2010.

Congress still needs to impose a permanent fix to these planned Medicare cuts, rather than simply using a broken system that continually requires emergency action to be patched. If this fix isn’t implemented, the pay cut will increase to 25% effective January 1, 2011.

Something Blue
Many O.D.s are definitely feeling blue this year as audits by third-party carriers, both refractive and medical, are on the rise. Worse yet, the financial implications of these audits are staggering—often into six figures. The pressure of heightened scrutiny is certainly increasing the need for better medical coding and compliance of the medical record. There is simply no place to hide any longer, and ignorance is no longer a viable defense. Real-time web-based reference sources as well as EMR systems are becoming the de facto standard in optometric practices today. In short, the best defense is a strong offense.

Next year will surely bring more changes, and along with them come opportunities, challenges, anxieties, frustrations and victories. I thank you for your questions and comments throughout the year. As the new year begins, I look forward to continuing the conversation.

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