Ankoor R. Shah, MD
ASRS CPT Advisor to the AMA
Retina Consultants of Houston
October has come and gone which means the leaves have changed colors, a new World Series Champion has been crowned (shameless plug for the Astros), and ICD-10 updates have been implemented. For all the faults of electronic medical records (EMR), the fact that these updates came and went on October 1, 2017 without much incident is a tribute to the advantages of EMR systems. Briefly, vision impairment and myopic degeneration codes were updated, but the latter are likely more impactful for retinal specialists so I’d like to take a moment to review them.
Myopic degeneration can now be broken into more granular categories. These include myopic degeneration (H44.2XX) with: choroidal neovascularization (A), macular hole (B), retinal detachment (C), foveoschisis (D), and other maculopathy (E). Myopic degeneration without the subset codes can also continue to be utilized.
Why It Matters:
Practically: Part B drugs such as ranibizumab, that have recently been approved to treat myopic choroidal neovascularization (mCNV), are also affected because their approval is linked to use with a certain ICD-10 code. Fortunately an exam of Genentech’s website indicate that H44.2A1 (mCNV OD) and H44.2A2 (mCNV OS) are already listed in addition to the older ICD-10 codes.
Long-Term: Merit-Based Incentive Payment System (MIPS) uses a “quality” component to help judge bonuses/penalties for Medicare payments. However treating a disproportionate number of myopic degeneration associated macular holes or retinal detachments may make you a “low quality” provider based on surgical success rates because they tend to be more challenging than their non-myopic counterparts. With the level of granularity of the ICD-10 data, there may be room to supplement the CPT codes that are used to determine single operation closure/attachment rates that would be used to judge physician quality.
Thus while EMR has minimized the coding hassle of ICD-10 changes, there are other aspects such as MIPS and reimbursement issues that still may require attention every October.