In response to the Academy's lobbying efforts, the Centers for Medicare and Medicaid Services has released a plan to resolve denied claims related to National Correct Coding Initiative (NCCI) edits implemented on July 1.

According to CMS, the denials are occurring as a result of a computer system issue that fails to recognize the appropriate modifiers (-24, -25, -57). The new edits apply to any global surgical code billed with an established patient eye-visit code appended with one of the appropriate modifiers. The agency said it will stop applying the new edits for all surgical codes to work on a permanent solution beginning on Oct. 1; the solution will be retroactive to July 1.

If your Medicare Administrative Contractor has a temporary fix to the computer issue in place, you may submit claims and they should be processed normally. However, if your Medicare Administrative Contractor has not implemented a temporary fix, CMS said that ophthalmologists may hold claims until Oct. 1, at which time those and others that have been inappropriately denied may be submitted or resubmitted for payment.

The Academy, with input from the American Society of Retina Specialists, continues to work directly with CMS on a permanent resolution. In addition, the Academy is working with Medicare Administrative Contractors through its Carrier Advisory Committee liaisons to implement temporary fixes before Oct. 1. So far three contractors have implemented temporary fixes: First Coast Service Options, Inc.; Noridian Healthcare Solutions, LLC; and Wisconsin Physician Services Insurance Corporation.

For more information, contact the Academy's Governmental Affairs Division at 202.737.6662