6
! " appeared in the Practice Strategies section of the August edition of the AOA Journal, and more compre- hensive questions and answers were found in the 8/16/04 issue of the AOA News. Yet more informa- tion on the final FCLCA rule, as well as a link to the Federal Regis- ter notice on the rule, can be found online at WWW.FTC.GOV/OPA/2004/06/CONTACTLENS.HTM. The Federal Register article is 118 pages long, the last 10 pages of which make up the actual Contact Lens Rule. The rule is easily read and understood. Dr. Quack sug- gests you take a few minutes to pe- ruse it sometime soon. It will be available on the NOA 3rd Party web page this month. The FTC has issued its final rule spelling out exactly what contact lens sellers and prescribers must do to comply with the new federal Fairness to Contact Lens Consum- ers Act. The FCLCA Requires prescribers (such as optometrists and ophthalmolo- gists) to provide patients with a copy of their contact lens pre- scription immediately upon completion of a contact lens fitting; Requires prescribers to provide or verify contact lens prescrip- tions to any third party desig- nated by a patient; Prohibits prescribers from plac- ing certain conditions on the release or verification of a con- tact lens prescription; Requires contact lens sellers either to obtain a copy of a pa- tient’s prescription or verify the prescription before selling con- tact lenses, and deems a pre- scription “verified” if, among other things, a prescriber fails to respond to a seller’s verifica- tion request within eight busi- ness hours; and Establishes minimum expira- tion dates for contact lens pre- scriptions. A comprehensive review of the rule

nebraska.aoa.orgnebraska.aoa.org/prebuilt/NOA/2004_08 Newsletter.pdfIn the past Medicare has been somewhat lenient with claims that contained out-dated ICD-9-CM codes. However, HIPAA

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appeared in the Practice Strategies section of the August edition of the AOA Journal, and more compre-hensive questions and answers were found in the 8/16/04 issue of the AOA News. Yet more informa-tion on the final FCLCA rule, as well as a link to the Federal Regis-ter notice on the rule, can be found online at

WWW.FTC.GOV/OPA/2004/06/CONTACTLENS.HTM.

The Federal Register article is 118 pages long, the last 10 pages of which make up the actual Contact Lens Rule. The rule is easily read and understood. Dr. Quack sug-gests you take a few minutes to pe-ruse it sometime soon. It will be available on the NOA 3rd Party web page this month.

The FTC has issued its final rule spelling out exactly what contact lens sellers and prescribers must do to comply with the new federal Fairness to Contact Lens Consum-ers Act. The FCLCA ♦ Requires prescribers (such as

optometrists and ophthalmolo-gists) to provide patients with a copy of their contact lens pre-scription immediately upon completion of a contact lens fitting;

♦ Requires prescribers to provide or verify contact lens prescrip-tions to any third party desig-nated by a patient;

♦ Prohibits prescribers from plac-ing certain conditions on the release or verification of a con-tact lens prescription;

♦ Requires contact lens sellers either to obtain a copy of a pa-tient’s prescription or verify the prescription before selling con-tact lenses, and deems a pre-scription “verified” if, among other things, a prescriber fails to respond to a seller’s verifica-tion request within eight busi-ness hours; and

♦ Establishes minimum expira-tion dates for contact lens pre-scriptions.

A comprehensive review of the rule

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��������������� ��Your New Resources

The Medicare Claims Processing Manual is a new manual that replaces current Medicare claims processing instructions for Medicare providers and contractors. Corresponding sections within current manuals will be removed within a few weeks. New instructions will be published in this manual. Manual transmittals through Re-vision Transmittal Number 1, dated Oc-tober 1, 2003, are included in this update. As new transmittals are included they will be identified on this page. To review individual transmittals, view the CMS Transmittal Web site. A crosswalk from the new manual to the source manual instruction is provided with each chapter. This crosswalk for the entire chapter may be accessed from the chapter table of contents. Also, the cross-walk for each section is shown immediately under the section heading.

CMS is transitioning from a paper-based manual system for its manual instructions to a Web-based system. The process includes the streamlin-ing, updating, and consolidating of CMS’ various program instructions into an electronic Web-based manual system for all users. The new system is called the online CMS Manual System and is located at

HTTP://WWW.CMS.HHS.GOV/MANUALS.

As CMS updates the program manual instructions, it will move that mate-rial into the new CMS Manual Sys-tem and eliminate the corresponding material from the outgoing paper-based manuals.

This will continue until all manual instructions are included in the CMS Manual System. In the meantime, you should check both sets of manuals for current policy and procedures.

New CMS Claims Processing Manual

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In the past Medicare has been somewhat lenient with claims that contained out-dated ICD-9-CM codes. However, HIPAA has changed the playing field. Effective for dates of service on and after Oc-tober 1, 2004, CMS will no longer provide a 90-day grace period for use of discontinued ICD-9-CM di-agnosis codes on Medicare claims. The Health In-surance Portability and Accountability Act (HIPAA) requires that medical code sets be date-of-service compliant, and ICD-9-CM diagnosis codes are a medical code set (see CR 3094 dated February 6, 2004 at: HTTP://WWW.CMS.HHS.GOV/MANUALS/PM_TRANS/R95CP.PDF ).

Updated ICD-9-CM codes are published in the Fed-eral Register in April/May of each year as part of the Proposed Changes to the Hospital Inpatient Pro-spective Payment System and are effective each October first. Physicians, practitioners, and suppli-ers must use the current and valid diagnosis code

that is in effect beginning October 1, 2004.

After the ICD-9-CM codes are published in the Fed-eral Register, CMS places the new, revised, and dis-continued codes on the following Website: HTTP://WWW.CMS.HHS.GOV/MEDLEARN/ICD9CODE.ASP

The update should be available at this site in June of each year.

ICD

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M Cat

GLC AMD

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LONDON (Reuters) - Tears might spread SARS, but by the same to-ken analyzing samples taken from tear ducts could also help with de-tecting the virus early, physicians in Singapore said.

Dr. Seng Chee Loon of the National University Hospital in Singapore and his colleagues found the virus in samples taken from tear ducts of 36 patients suspected of being in-fected last year.

Three of the eight patients who had probable SARS had the virus in their tears. All of them were newly infected, and in one patient the vi-rus was only found in the tears. "This is the first case series reported with the detection of the SARS

coronavirus from tears and has im-portant implications for the practice of ophthalmology and medicine," Dr. Loon said in a report in the July issue of the British Journal of Oph-thalmology.

The investigators did not find the virus in the tears of other patients whose symptoms started earlier. "As all three positive cases had sampling performed early in the course of their illness, we hypothe-sise that the secretion of virus in tears occurs only during the early phase of the disease," he said. The findings suggest that the virus can be detected and isolated in the early phase of infection and could be an important diagnostic tool. But it also may mean that the virus could be spread through tears, in addition to droplets from coughs or sneezes, which could pose an addi-tional health hazard for healthcare

workers and the general public. "Ophthalmic practices may need to change as more stringent barrier methods, appropriate quarantine, and isolation measures are vital when managing patients with SARS," Dr. Loon added. Br J Ophthalmol 2004;88:861-863.

SARS Virus Found in Tear Specimens�

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HPSA Changes In Nebraska

Deuel County will be dropped from the Health Professions Shortage Area list as of 9/1/04, and will no longer be able to use the QB modifier. In the Arnold area of Lincoln County, both Garfield and Antelope precincts will be added to the HPSA list as of 9/1/04, and can file professional services with a QB modifier. For more information go to our Medicare Carrier’s web site:

HTTP://WWW.KANSASMEDICARE.COM/PART_B/MANUALS/PHYS_MAN/PHY_HPSA_APPA.PDF.

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Dr. Quack continues to receive questions about punctal plug coding. The following coding information is for those ODs who may no longer have a copy of Dr. Quack’s previous article and don’t have access to it on the web.

1) These directions are based on the Vision Section of the printed Medicare Physician’s Manual (which is soon to be replaced by CMS on-line manuals. See page 2). Dr. Quack recommends you file likewise with all third parties, including BCBS, UHCM, Midlands Choice, et cetera. Dr. Quack’s examples are below.

2) When you use the –50 modifier, the units should be one, and the dollar amount could be twice what you charge for one eye. You will be reimbursed at 150% of allowable for one eye when you use the –50 modifier.

3) When occluding 3 puncta, follow the Medicare directions in the use of the –50 and –51 modifiers. The total services charges could be 3 times as much as for one punctum, and so forth. Reimbursement will be further diminished for the 3rd and 4th plugs if used.

4) CPT & Medicare do not differentiate between the insertion (68761) of temporary versus permanent plugs. Only the A-code for the plug differs. [No A-code is used for Medicare patients since the materials are bundled with the procedure.]

5) When inserting permanent plugs use A4263 for the materials. Put this charge on the line below the services codes, and make the units the number of plugs provided. When inserting temporary plugs use A4262; however you may not be reimbursed for the cost of the temporary plugs. [Medicare now bundles (combines) the payment for the insertion procedure and for the materials regard-less if they are permanent or temporary plugs, so no A-code is used with Medicare patients.]

6) Don’t worry about the E- modifiers to indicate which punctum was closed; apparently they are not needed. 7) Doctors not participating in Medicare must remember their limiting charges, of course. ����������� ������������������� ������������������� ������������������� ��������($X is what you charge for insertion of one plug; $Y your material charge for one plug): One Punctum, One Permanent Plug Date CPT/HCPCS Code Charge Units Dr. Quack’s comments ... 12/25/2001 68761 $X 1 12/25/2001 A4263 $Y 1 (omit this line for Medicare patients) Two Puncta in Same Eye, Two Permanent Plugs Date CPT/HCPCS Code Charge Units 12/25/2001 68761 $X 1 12/25/2001 68761-51 $X 1 This line reimbursed at 50% of one eye 12/25/2001 A4263 $2Y 2 (omit this line for Medicare patients) Two Puncta, One per Eye, Two Permanent Plugs Date CPT/HCPCS Code Charge Units 12/25/2001 68761-50 $2X 1 This line reimbursed at 150% of one eye 12/25/2001 A4263 $2Y 2 (omit this line for Medicare patients) Three Puncta, Three Permanent Plugs Date CPT/HCPCS Code Charge Units 12/25/2001 68761-50 $2X 1 This line reimbursed at 150% of one eye 12/25/2001 68761-51 $X 1 This line reimbursed at 25% of one eye 12/25/2001 A4263 $3Y 3 (omit this line for Medicare patients) Four Puncta, Four Permanent Plugs Date CPT/HCPCS Code Charge Units 12/25/2001 68761-50 $2X 1 This line reimbursed at 150% of one eye 12/25/2001 68761-50-51 $2X 1 This line reimbursed at 50% of one eye 12/25/2001 A4263 $4Y 4 (omit this line for Medicare Patients)

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Dear Dr. Quack, We are thinking about purchasing a pachymeter, but we note that the reimbursement for pachymetry is limited. Are we required by Medi-care to use a pachymeter? ����������������������������������������������������������������

You are correct that the reimburse-ment for pachymetry is limited. In fact BCBS considers pachymetry as part of your examination, and pays nothing. However, that does not obviate the eye care practitioner

from needing to perform this ser-vice on certain patients. Since the Ocular Hypertensive Treatment Study (OHTS) was published, once-in-a-lifetime pachymetry readings are the standard of care for evaluat-ing and following glaucoma sus-pects and ocular hypertensives, and probably for monitoring treatment of glaucoma patients as well. (However, Medicare does not reim-burse for pachymetry on patients who already have a glaucoma diag-nosis.) What should a provider do if they don’t wish to invest $2500 in a pachymeter, but wish to follow pa-tients with glaucoma related diag-noses? One alternative is to share the instrument with other providers. By sharing and then making special pachymetry appointments, the in-strument need be in your office only once a month or so. Dr. Quack and his partners have used such special appointments at our satellite office for some time, and it has worked quite smoothly. An-other alternative is to refer the pa-tient to a colleague for the once-in-

a-lifetime pachymetry reading. The most important point, though, is that a pachymetry reading should be on-hand for patients with all glaucoma related 365.xx diagnoses. Otherwise you are putting your pa-tients at risk, and yourself as well. If you would like more information on the Ocular Hypertension Treat-ment Study, go to

HTTP://WWW.NEI.NIH.GOV/GLAUCOMAEYEDROPS/OHTS_BACKG.ASP

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~~~~~~~~~~~~~~~~~~~~~~~~~~ ����������������������������� �������������!�������������������������������� �������������!�������������������������������� �������������!�������������������������������� �������������!�����������

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Pachymetry: A New Standard of Care

Since the Ocular Hypertensive

Treatment Study (OHTS) was

published, once-in-a-lifetime

pachymetry readings are the

standard of care for evaluating

and following glaucoma sus-

pects and ocular hypertensives,

and probably for monitoring

treatment of glaucoma patients

as well.

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asked the doctor, "be a little more specific."

Dr. Quack touched his right knee with his feathery finger and yelled, "Ouch! That hurts!" Then he touched his left cheek and again yelled, "Ouch! That hurts, too!"

Dr. Quack went to his physician a while back complaining of lots of pain.

"Where are you hurting?" asked his doctor.

"You have to help me, I hurt all over", said Dr. Quack.

"What do you mean, all over?"

Then he touched his right earlobe, "Ouch!! even THAT hurts!", he cried.

The MD looked at Dr. Quack thoughtfully for a moment and then gave his diagnosis, "Quack, I think you have a broken finger."

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�� �� � � � �� �� � � �� � � � � � � �� � � � � � � � �� �� � � �� � � The FTC has issued its final rule spelling out exactly what contact lens sellers and prescribers must do to comply with the new federal Fairness to Contact Lens Consumers Act [p. 1] �

�� � � � � �� � �� � � � � � � ���� � � �� � � �� � � � � �� � ��

CMS is transitioning from a paper-based manual system for its manual instructions to a Web-based system called the online CMS Manual System and is located at http://www.cms.hhs.gov/manuals. As CMS updates the program manual instruc-tions, it will move that material into the new CMS Manual System and eliminate the corresponding material from the out-going paper-based manuals. [p. 2]

The Medicare Claims Processing Manual is a new manual that replaces current Medicare claims processing instructions for Medicare providers and contractors. Corresponding sections within current manuals will be removed within a few weeks. [p. 2] �

� � � ���� ����� �� � � � �� � � �� � ��� � � � � �Effective for dates of service on and after October 1, 2004, CMS will no longer provide a 90-day grace period for use of discontinued ICD-9-CM diagnosis codes on Medicare claims due to HIPAA [p.3].

� � � � �� �� � � �� � � � ��� � � � � �� � � ��� � � � Tears might spread SARS, but by the same token analyzing samples taken from tear ducts could also help with detecting the virus early, physicians in Singapore said. [p. 3]

� � � � ��� � � � � ��� �� � � � � � � � Deuel County will be dropped from the Health Professions Shortage Area list as of 9/1/04, and will no longer be able to use the QB modifier. In the Arnold area of Lincoln County, both Garfield and Antelope precincts will be added to the HPSA list as of 9/1/04, and can file professional services with a QB modifier. [p.3]

� � � � � � �� � � �� � �� �� Dr. Quack continues to receive questions about punctal plug coding on occasion. Complete instructions are included in this repeat article for those that may no longer have access to the previous article. [p. 4]

� � �� � � � � � �� � � �� � � � � � � � � ��� � � �� � �� � � �� �� � � � � �

Since the Ocular Hypertensive Treatment Study (OHTS) was published, once-in-a-lifetime pachymetry readings are the stan-dard of care for evaluating and following glaucoma suspects and ocular hypertensives, and probably for monitoring treat-ment of glaucoma patients as well. (However, Medicare does not reimburse for pachymetry on patients who actually have a glaucoma diagnosis.) [p. 5]

ABSTRACTS OF THIS MONTH’S ISSUE