Triple Threat: Combination OMNI and Hyrdus

Roman Krivochenitser, MD

Eyetube

Roman Krivochenitser, MD, demonstrates canaloplasty, goniotomy, and stenting in one procedure, highlighting techniques to maximize success with MIGS. Financial Disclosure: Consultant (Alcon)

Papilledema Associated With Meningioma

Even if you suspect idiopathic intracranial hypertension, it’s important to order appropriate imaging and workup to rule out more serious causes of papilledema.

Christopher J. Borgman, OD, FAAO, and Rick Savoy, OD, MPH

Modern Optometry

A 45-year-old Black female was referred to us for a second opinion on possible edematous optic nerves after being seen 1 week earlier. The patient reported having headaches that worsened over the past year. She denied trauma and changes to her vision; her ocular history was unremarkable. She also denied systemic medical issues and allergies and was taking only a daily multivitamin. EXAMINATION FINDINGS The patient’s entering VA was 20/20 OU. Her pupils were equal, round, and reactive to light, without afferent pupil defect. Extraocular motilities showed full range of motion OU, and the patient denied experiencing diplopia. Confrontation visual fields were full to counting fingers OU. Color vision was normal with Hardy-Rand-Rittler testing OU. The patient’s anterior segment was also normal for her age OU.

How to Implement the –JZ Modifier

Reporting zero waste when administering therapeutics is going to look a little different this year. Here’s why.

Joy Woodke, COE, OCS, OCSR

Retina Today

Reporting drug usage and waste in the retina clinic has always been trickier than you would expect. Given the sheer volume of therapeutics used to treat everything from diabetic eye disease to AMD—and now geographic atrophy—it’s a crucial coding skill to have. Since 2017, to obtain full reimbursement for single-dose containers, vials, and packages for both the injected and discarded amounts of a drug, 1 unit or greater, physicians have reported the –JW modifier, discarded drug not administered. The Centers for Medicare and Medicaid (CMS) have monitored the use of the –JW modifier and, because of noncompliance, have reported incomplete data on drug wastage. As a result, the CMS created a new modifier, –JZ, zero drug amount discarded/not administered to any patient, that went into effect January 1, 2023.1 Collectively, the claims data from the –JW and –JZ modifiers will be used to calculate discarded drug refunds for manufacturer rebate requirements. Physicians shouldn’t be too surprised, considering CMS announced this change in their Final Rule in November 2022.1 The –JZ modifier was effective starting January 1, 2023, but the required use of the –JZ modifier was set for July 1, 2023. This new modifier will be appended to the Healthcare Common Procedure Coding System (HCPCS) code representing the drug used. If not reported when applicable, claims could be subject to audits, and if not used by October 1, 2023, claims may be returned as unable to process. The –JW and –JZ modifiers are required for single-dose containers, vials, and packages based on the FDA-approved labeling. It is important to confirm if the drug is considered a single dose by reviewing the vial or package labeling.