Objective
To describe patient preferences regarding payment for blepharoplasty and blepharoptosis
repair and physician practices before and after the 2009 change in reimbursement for
these 2 procedures by the Centers for Medicare and Medicaid Services (CMS).
Design
Cross-sectional study.
Participants
Fifty patients presenting for functional blepharoplasty and blepharoptosis repair
at an academic oculoplastic practice and 198 members of the American Society of Ophthalmic
Plastic and Reconstructive Surgery.
Methods
A 5-question paper survey was administered to patients, and a 5-question web-based
survey was distributed to 510 unique physician e-mail addresses obtained from the
American Society of Ophthalmic Plastic and Reconstructive Surgery mailing list server
in 2010.
Main Outcome Measures
The surveys elicited patient knowledge and attitudes regarding the reimbursement policy
of the CMS and physician knowledge and behaviors before and after the reimbursement
policy change.
Results
Ninety-one percent of patients would be opposed to having to pay out of pocket for
blepharoplasty or having to wait at least 3 months after ptosis repair to have a blepharoplasty.
When asked to choose between these options, 62% of the patients would rather have
the 2 surgeries performed separately than pay out-of-pocket. Before the reimbursement
policy change by the CMS, 77% of oculoplastic surgeons performed blepharoplasty and
blepharoptosis repair in the same sitting, whereas 37% did so after the policy change
(
P < 0.001). Compared with before the policy change by the CMS, more surgeons performed
the 2 procedures at least 3 months apart (4% before vs. 29% after,
P < 0.001) and more often billed patients for a cosmetic blepharoplasty (5% before
vs. 12% after,
P = 0.009).
Conclusions
Our study suggests that oculoplastic surgeons have made a change in the delivery of
ptosis and blepharoplasty surgical services after the reimbursement policy change
for these procedures by the CMS in 2009. This change, in which patients undergo separate
surgical visits for ptosis repair and blepharoplasty, is not desirable to most patients.
Abbreviations and Acronyms:
CMS ( Centers for Medicare and Medicaid Services), NCCI ( National Correct Coding Initiative)To read this article in full you will need to make a payment
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References
- National Correct Coding Initiative Coding Policy Manual for Medicare Services. Version 16.3. American Medical Association, Chicago, IL2009 (VIII–10)
Centers for Medicare and Medicaid Services. Local coverage determination (LCD): blepharoplasty, blepharoptosis and brow lift (L29973). Available at: http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=29973&ContrId=50&ver=24&ContrVer=1&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=Minnesota&CptHcpcsCode=15823&bc=gAAAABAAAAAAAA%3d%3d&. Accessed January 2, 2014.
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Article Info
Publication History
Published online: February 18, 2014
Accepted:
January 3,
2014
Received in revised form:
December 29,
2013
Received:
August 27,
2013
Footnotes
Supplemental material is available at www.aaojournal.org.
Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Funding: Research to Prevent Blindness.
Dr. Levin is now with the Horizon Eye Specialists in Phoenix, Arizona.
Identification
Copyright
© 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.
