BULLETIN FROM THE EYE CARE BENEFITS CENTER

VOLUME NO. 65
BULLETIN NO. 33
June 19, 2007

BACKGROUND:
On December 20, 2006 the President signed the Tax Relief and Health Care Act of 2006 (TRHCA). Section 101 under Title I authorizes the establishment of a physician quality reporting system by CMS. CMS has titled the statutory program the Physician Quality Reporting Initiative (PQRI).

PQRI establishes a financial incentive for eligible professionals to participate in a voluntary quality reporting program. Eligible professionals who successfully report a designated set of quality measures on claims for dates of service from July 1 to December 31, 2007, may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

PROBLEM OR ISSUE TO BE ADDRESSED:
CMS revised the "2007 PQRI Specification Guidance" regarding the Cataract Measures as of 6/1/2007. Please note that this Bulletin is an update to the PQRI article listed in the June 18, 2007 issue of the AOA News.

Measure #16 Cataracts: Documentation of Pre-Surgical Axial Length, Corneal Power Measurement and method of Intraocular Lens Power Calculation.

Revised Instructions: This measure is to be reported each time a cataract surgery (in either one or both eyes) with intraocular lens (IOL) placement is performed during the reporting period. It is anticipated that clinicians who perform the cataract procedure will submit this measure. When reporting the measure, submit the listed CPT procedure codes and the appropriate CPT Category II code or the CPT Category II code with the modifier.

Denominator Coding: A CPT procedure code is required to identify patients who underwent cataract surgery (in either one or both eyes) with IOL placement for denominator inclusion. CPT procedure codes (without modifier 55): 66982, 66983, 66984
Measure # 17 Cataracts: Pre-Surgical Dilated Fundus Evaluation

Revised Instructions: This measure is to be reported each time a cataract surgery (in either one or both eyes) with or without intraocular lens (IOL) placement is performed during the reporting period. It is anticipated that clinicians who perform the cataract procedure will submit this measure.

Denominator Coding: same as above. CPT Procedure Codes (without modifier 55): 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984

The AOA encourages participation in the PQRI program. The use of these measures is voluntary; therefore the AOA wants all Optometrists who file insurance claims to be aware of the impact of the revised cataract measures. This change in guidance means that there are six measures that will be counted for optometry. The two cataract measures may be submitted but will not be counted as one of the three (3) measures that need to be billed with the category II codes at least 80% of the time in order to qualify for the bonus.

We want the membership to understand that CMS has indicated any claims submitted with the -55 modifier appended to the cataract surgical codes will not be considered in the calculation of the 1.5% bonus payment. If you plan to participate in the PQRI program, specifically as it relates to the cataract measures, the submission should be considered at the discretion of the individual provider.

AOA members are advised to visit the AOA Quality Reporting webpage at www.aoa.org/PQRI.xml for the latest updates to the PQRI program.

For questions regarding PQRI Coding, Please contact Sheila Dwyer 703-837-1344 or SCDwyer@aoa.org.

For questions regarding PQRI Policy, Please contact Jodi Chappell Mitchell 703-837-1348 or jchappell@aoa.org.

720 Light Street, Baltimore, MD 21230 TEL: (410) 727-7800• FAX: (410) 752-8295 EMAIL: MOA@assnhqtrs.com