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PRESIDENTâ€™S MESSAGE By Robert L. Bergren, MD

Society Membership is Vital to Our Profession

he month of March brings with it spring and once again we start anew. The new year is already off to a fast start and our initial focus is on membership and the new legislative session. Starting off the new year, the PAO will work to keep and build our membership. Although most ophthalmologists are AAO members, only about half of nationwide ophthalmologists are state society members. These state societies, including the PAO, are crucial to all ophthalmologists and patients with eye disease. It may seem like the federal government controls much of what we do, but those are federal regulations governing payment from Medicare. The laws governing the practice of medicine are state laws. So,

logical society has, or should have, a lobbyist who is monitoring proposed legislation which may impact ophthalmologists or their patients. In small states with few members - because there are few ophthalmologists - this is more difficult. In that case the lobbying efforts are combined with the state medical society, but that is not ideal. In Pennsylvania we have an excellent lobbying firm but that requires money and that money comes from your membership. This is one reason we are pushing for inIf you have not yet the state controls memberrenewed your membership, creased what physicians, ship. If you have do so today. nurses, optomenot yet renewed your membership, trists, physician assistants, and other do so today. Make sure your partners ancillary medical personnel are al- are members. Simply tell them to go to lowed to perform. www.paeyemds.org. Itâ€™s easy to join. The board is working hard to reach all A vital role of any state society is to non-members with a personal phone monitor what is happening politically, call. Simply said, if you are an ophwhich could change how medical care thalmologist in the state of Pennsylvais practiced. Each state ophthalmoContinued on page 3

LEGISLATIVE UPDATE by David I Silbert, MD, President-Elect, Pennsylvania Academy of Ophthalmology

It’s Back - Your Help is Needed Now By Kenneth P. Cheng, MD Legislative Chair, PAO, Chair, AAO Surgical Scope Fund

s you should all know by now, optometry’s scope bill of last session was stopped in November when it failed to advance in the House Professional Licensure Committee and the session ended. Sorry to say but, as expected, It’s Back. Senator Gordner’s Modernization of the Optometric Practice and Licensure Act, SB 391 was introduced on March 5th. It is very much the same bill as last year. Optometrists all across Pennsylvania were invigorated when the bill last year quickly and by an overwhelming

majority vote, passed in the Senate. They were disappointed and frustrated when the bill did not advance on the House side and all reports are that they have been very actively contacting their legislators since the session ended last November. Now is the time again to contact your legislators to tell them to vote NO on SB 391. Go to www.legis.state.pa.us and follow the links to Find Your Legislator.

Talking points: • Vote NO on SB 391 • The bill says no scissors, scalpels, or therapeutic or refractive lasers but don’t be deceived – There are a multitude ways to cut tissue without a scissors or scalpel and laser surgery can be cosmetic, preventative (Laser PI), or rehabilitative (YAG capsulotomy). • The prohibition on systemic treatment has been removed – Optometrists shouldn’t be treating diabetes or hypertention. • SB 391 allows them to prescribe virtually any medication, by any route of administration, including intravenously. They simply are not qualified to do this. • Ophthalmologists only very rarely prescribe narcotics – SB 391 would allow the thousands of optometrists in PA to prescribe narcotics when they have no reason to do so. Pennsylvania’a opoid abuse problem is amongst the worst in the country. • SB 391 removes the requirement for optometrists to identify themselves as optometrists. Why do they want this change? Shouldn’t the public be informed on what kind of doctor they are seeing? • Optometrists do not have equivalent education and training to physicians. They should not be practicing medicine and surgery, which is what SB 391 allows them to do. • Vote NO on SB 391

If more Pennsylvania Ophthalmologists don’t let their legislators know that we are their constituents and that our patients are their constituents, optometry will be performing lasers and surgery in Pennsylvania, on your patients, in the near future. Your legislators are hearing from optometry, they need to hear from you! The question continues to come up, “last year’s bill plainly said no surgery with a scalpel or scissors and no therapeutic laser – Why are we saying that the bill includes surgery?”. The answer is in the language. In legislation introduced across the country, optometry uses the tactic of using inclusionary language, “treatment of diseases of the visual system by any means” and then adds exclusions that are either vague or ambiguous or designed to be removed later on the slippery slope of, “we are doing _____ surgery so we should be allowed to perform _____. SB 391’s exclusions are filled with loopholes – Continued on page 8

PRESIDENT’S MESSAGE Society Membership is Vital to Our Profession continued from page 1

nia and you are not a PAO member, you are letting down your profession and your patients. A new year brings a new legislative session. Last year things were very busy for us in the legislature. We were successful in stopping a challenging bill that would have allowed non-physician practitioners to perform procedures for which they are not trained, thus endangering patients. We also supported pediatric screening legislation that helps with early detection of eye problems. All of this is detailed in Ken Cheng’s legislative report enclosed in this issue of FOCUS. We hope to organize a local advocacy day in early summer to support our legislative efforts. Instead of several people gathering in Harrisburg to meet with legislators on a single day, we hope to organize a greater number of ophthalmologists to meet with their legislators when they are away from Harrisburg and in their local offices. Legislators in their local offices have less distractions and are eager to meet their constituents and hear their concerns. The PAO will continue supporting state ophthalmologists for fair payment and for fair treatment from insurance carriers in the state. There are a few carriers asking the PAO

for our opinion on coverage changes or coverage statements. This usually works well, and we encourage this. Sometimes changes are made without input, and that’s where problems can occur. Many insurance issues are global and require the work of our national societies. There are, however, several local coverage issues, and that is where the PAO is helpful. The PAO will be bringing CODEquest to each third of the state again this Spring on May 15, 16 and 17 in Mars, Harrisburg, and Philadelphia respectively. These valuable seminars can help you and your staff boost coding performance, prepare to handle audits, resolve claim denials, and help protect your practice. Make sure you monitor your inbox for our monthly inSight newsletter. This e-publication will bring you the latest updates on legislative, billing, and other relevant issues that could affect your practice. The PAO will continue to work to serve the needs of Pennsylvania’s ophthalmologists and Pennsylvania citizens who deserve high quality eye care. Please join me in supporting this most worthwhile organization as we, together, work to support the future of our medical specialty and our patients.

Codecuest THE ACADEMY’S

CODING COURSE

2019

Pennsylvania Academy of Ophthalmology

Philadelphia: May 17, 2019 Live Stream: May 17, 2019 The Eye Physicians and Surgeons

Coding Corner CODING AND COMPLIANCE UPDATE By:Joy Newby, LPN, CPC | Newby Consulting,Inc.

ICD-10 Updates Effective October 1, 2018

Medicare CodingPlease Is Modernized forcode Virtual This list is not all-inclusive. refer to the 2019 ICD-10 book. and Remote Care By Deanna Field, Practice Support Specialist, Pennsylvania Medical Society

n Nov. 1, 2018, the Centers for Medicare and Medicaid Services (CMS) finalized the 2019 Medicare Physician Fee Schedule (MPFS), introducing reimbursement for Virtual Care, Remote Monitoring, and Interprofessional Consultations. The rule also eased documentation requirements for Evaluation and Management (E&M) visits. Virtual Care Routine coding changes happen annually, but this year’s rule shows that CMS is committed to bringing virtual care to seniors. CMS has introduced reimbursement for two codes that recognizes physicians’ work done outside the traditional office visit. The following are services using communication technology as either a “virtual check-in “or “store and forward” technology to evaluate if an office visit is warranted. Traditionally, these types of services would be bundled into an E&M visit code; however, CMS believes this new policy using communication technology can mitigate unnecessary office visits. As of Jan. 1, 2019, CMS is paying the following new HCPCS codes: • G2012: Brief Communication Technology-Based Service (or virtual check-in), submitted by a billing practitioner who can report E&M services. To bill this service separately, the communication must not originate from a related E/M service provided within the previous 7 days, nor lead to an E/M service or procedure within the next 24 hours. • G2010: Remote evaluation of patient-transmitted information pre-recorded known as “store and forward” video or image technology, including interpretation with follow-up with the patient within 24 business

hours. This service can only be billed separately if the interaction does not result in an office visit within 7 days of the remote service, nor originate from a related office visit from 7 days prior. Items to note when billing these services: • G2012 cannot be billed for telephone calls that involve only clinical staff. • G2012 and G2010 are Medicare Part B services; cost sharing by the patient will apply. • Patient consent is required; verbal consent is acceptable if it is documented in the patient’s medical record. • Services are limited to established patients only. CMS uses the Current Procedural Terminology (CPT®) definition as a patient that has received professional services from a physician, or other qualified health care professional of the exact specialty and subspecialty who belongs in the same group practice, within the past 3 years. • Currently, there are no frequency limits. • The patient is not required to be in a specific location in order for the patient to receive virtual care services. Remote Patient Monitoring CMS has finalized separate payment for newly created chronic care remote physiologic monitoring codes; however, the types of technology that will qualify are not yet defined. CMS is expected to provide sub-regulatory guidance soon. PAMED will update its members once this guidance is released. Continued on page 5

Coding Corner

Medicare Coding Is Modernized for Virtual and Remote Care Continued from page 4

Codes eligible for reimbursement include: • 99453: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial set-up and patient education on use of equipment. • 99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. • 99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month, requiring interactive communication with the patient/caregiver during the month. Interprofessional net Consultation

Telephone/Inter-

The MPFS final rule unbundles four existing codes (CPT codes 9944699449) and introduces two new CPT codes developed by the American Medical Association (AMA) Digital Medicine Payment Advisory Group (CPT codes 99451 and 99452). As stated in the final rule, “The six codes describe assessment and management services conducted through telephone, internet, or electronic health record consultations furnished when a patient’s treating physician or other qualified health care professional requests the opinion and/or management of the patient’s problem without the need for the patient’s faceto-face contact with the consulting physician or qualified health care professional.”

tative physician should not have had a face-to-face encounter with the patient within 14 days and the code should not be reported if the consultation leads to the transfer of care or any other service involving a face-to-face service with the patient. Descriptions for CPT codes 99446-99449 have been updated from 2014 and now include the assessment of electronic health records as part of the consultation service. • 99446: Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician including a verbal and written report to the patient’s treating/ requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review • 99447: 11-20 minutes • 99448: 21-30 minutes • 99449: 31 minutes or more • 99451: Interprofessional telephone/internet/ electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 or more minutes of medical consultative time. • 99452: Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional, 30 minutes. This service is reported by the physician or other qualified health care professional who is treating the patient and consulting for medical advice or opinion, not for transfer of care.

Reimbursement for these services support a teambased approach to care that doesn’t include physician interaction with the patient. The goal is to increase efficiency for both patients and physicians while decreasing the need for additional appointments when Interprofessional Consultation is sufficient.

Items to note when billing these services:

These time-based services can be used for both new and established patients with either a new problem or an exacerbation of an existing condition. The consul-

• CPT codes 99446-9449 require verbal and written feedback with the majority (greater than 50 percent) of

• Billing for interprofessional services is limited to practitioners that can independently bill E&M services. Only the consultative physician can report CPT codes 99446-99449 and 99451.

Continued on page 6

Coding Corner

Medicare Coding Is Modernized for Virtual and Remote Care Continued from page 5

the service spent providing medical consultative verbal or internet discussion. Time reviewing pertinent medical records and diagnostic results are included with this service and is not separately reported. • CPT code 99451 is based on time when review of medical record and diagnostic results are more than 50 percent of the 5 minutes or more of medical consultative time and concludes with a written report. • Verbal consent must be documented in the patient’s medical record for each consultation. • This is a Medicare Part B service and cost sharing will apply. Documentation Changes Effective Jan. 1, 2019, CMS simplified the documentation requirements by eliminating redundancies that do not require changes in coding or payment.

• For new and established patient office-based E&M visits, physicians will no longer be required to re-enter the patient’s chief complaint and history that has already been entered (by staff or beneficiary), provided that the physician indicated in the medical record that the information was reviewed and verified. • For office-based established patient E&M visits, physicians may focus documentation on what has changed since the last visit, or pertinent items that have not changed, and update the medical record as needed. CMS notes the physicians who decide to adopt this way of documenting should review prior data and indicate in the medical record that they have done so. PAMED has several Quick Consult fact sheets on the MPFS. PAMED members can access them at www.pamedsoc.org/ MPFS. Members who have additional questions can contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

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Legislative Update

Now is the Time to Contact Your Legislators About SB391 Continued from page 2

Think of ways to cut or penetrate tissue without scissors or scalpel; punches for skin biopsy, radiofrequency cutting/ cautery, and consider whether a YAG capsulotomy is therapeutic or rehabilitative or whether a laser peripheral iridotomy is preventative. SB 391 is the same broad reach into the practice of medicine and surgery as last session’s bill. Now is the time to introduce yourself, or remind your legislator that you are there, and to educate them on what is required to safely perform surgery on them, their family, and the patients of Pennsylvania. Appropriate education and training to perform eye surgery consists of medical school, internship, and ophthalmology residency – Period. There are no shortcuts that are safe or acceptable, certainly not optometry school and weekend courses for the practicing

optometrist. The PAO fought this battle, with the help of many members as well as non-members, and we delayed optometric surgery in Pennsylvania last year. This is a nationwide battle with 12 other states plus Puerto Rico facing optometric surgery proposals right now and an additional 12 felt to be threatened right now. Organized optometry will not give up their quest for surgery. The ongoing battle will only be won if more ophthalmologists take a stand now and help with the fight. Encourage others to be members of the PAO, contribute to the PA Eye PAC and to the AAO’s Surgical Scope Fund and answer the call to help when needed. Help is needed now. You must call your Senator and Representative NOW.