Payment considerations for dropless cataract surgery – Ophthalmology Management

In May, the author of an article in Ophthalmology Management quoted a physician as saying that dropless cataract surgery “is a no-brainer.” The author said Imprimis Pharmaceuticals has commercialized two compounds, TriMoxi and TriMoxiVanc, for this purpose and is promoting the concept to an expanding audience of surgeons.

He discusses reimbursement issues briefly, but these are the concerns that present problems because the reader gets the impression that few (if any) obstacles exist to recouping their costs—and that’s not the case.

This article addresses the following issues:

  • The Outpatient Prospective Payment System pass-through exception is not applicable.
  • TriMoxi and TriMoxiVanc are not listed on CMS’ table of injectable medications that are separately reimbursed in an ASC or HOPD at this time.
  • When TriMoxi or TriMoxiVanc is administered in the operating room, the reimbursement for the supply is included in the ASC’s facility fee.
  • Since the use of TriMoxi and TriMoxiVanc is described as “dropless cataract surgery,” the intravitreal injection is an integral component of the cataract procedure, and consequently not reported separately.
  • While dropless cataract surgery appears to be attractive to surgeons and patients, the question of separate reimbursement is a sticking point. We looked at this issue from every vantage point, and found that Medicare considers the supply and administration of TriMoxi or TriMoxiVanc to be an incidental part of cataract surgery and not separately reimbursed.

This article was published in Ophthalmology Management, and was written by Corcoran’s President, Kevin Corcoran, COE, CPC, CPMA, FNAO. To view the entire article, click on the link below:


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