Grass-roots activism critical for retina field

Dr. Parke, president and chief executive officer, Dean A. McGee Eye Institute, and the Edward L. Gaylord professor and chairman, department of ophthalmology, University of Oklahoma, Oklahoma City, discussed some of the short-term concerns of vitreoretinal subspecialists.

As of now, the AAO has submitted 11 codes to the CMS that are considered to be undervalued and the CMS has identified 14 codes that are believed to be overvalued, among them 67038 and 67228 (vitrectomy with membranectomy and panretinal photocoagulation), which Dr. Parke described as important to the vitreoretinal community.

Dr. Parke explained that the AAO is conducting a study to determine accurate work values and, when appropriate, to defend the current values from the proposed cuts and fight for fair reimbursement.

The results of the study were scheduled to be presented at the full AMA/Specialty RVS Update Committee in September. Changes arrived at during this process will be implemented in 2007.

Dr. Parke discussed the problems associated with the proposed cuts.

"The intraservice time, defined as the time required to perform a procedure, of almost all of the major retinal codes has probably dropped since the time that the initial surveys were done more than 10 years ago. For example, in cataract surgery the intraservice time was estimated to be 50 minutes. Few of us know a competent cataract surgeon who would take an average of 50 minutes to do the procedure. Interestingly, fluorescein angiography was never part of the survey," Dr. Parke said.

In a discussion of how some major codes are valued, he pointed out that for code 67038 (vitrectomy and membranectomy) with a 21.21 work value, the current intraservice time for the procedure is 176 minutes, requiring 8.5 total physician visits. For code 67228 (panretinal photocoagulation), the intraservice time is currently based at 69 minutes; this is being re-evaluated.

"To look at this from another perspective, the process compares what we do as vitreoretinal surgeons with what is done in medicine globally. For example, code 67038, which has an intraservice time of 176 minutes, is considered comparable to hip revision and pericardiectomy, in that the procedures have similar intraservice times and numbers of total visits. These are the sort of existing comparisons that ophthalmologists, the AAO, and the ASRS have to deal with as we go through this process. This is why there will likely be some changes in the reimbursement mechanism," he emphasized.

Dr. Parke put changes in cataract surgery and YAG laser work values, the two codes with the highest volumes, into perspective.