Objective To assess ophthalmologist-level changes on cataract surgery bills and to assess patient and ophthalmologist characteristics associated with complex cataract surgery coding. Set up a cross-sectional study. Design retrospective series.
Methods Medicare beneficiaries aged 65 years or older who underwent cataract surgery between January 1, 2016, and December 31, 2017, were included. A comparison of complex cataract surgery billing versus routine and patient and physician characteristics associated with complex cataract surgery billing were assessed.
Results In 2016 and 2017, an estimated 3.5 million cataract surgeries were performed on Medicare beneficiaries.Male (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.75-1.82), patients 75+ years (patients 65+ years) to 74 years: OR, 1.35; 95% CI, 1.33-1.36 ), and ethnic minorities (Black vs White: OR, 1.80; 95% CI, 1.75-1.85) had increased odds of coding cataract surgery as a complex case. The average coding rate for complex cataract surgery performed by individual surgeons in the United States (n = 10075) was 11.2%, with wide variation. High-risk clinical diagnostic codes were associated with 40.0% of complex cataract surgeries. After adjusting for patient characteristics, ophthalmologists who graduated from medical school within the past 10 years (OR, 1.35; 95 % CI, 1.22-1.49) were more likely to code for complex cataract surgery. A high-volume ophthalmologist is less likely to write code for complex cataract surgery than a low-volume ophthalmologist. Conclusions There are significant differences among ophthalmologists in complex cataract surgery.High-risk clinical diagnostic codes were associated with 40.0% of complex cataract surgeries. After adjusting for patient characteristics, ophthalmologists who graduated from medical school within the past 10 years (OR, 1.35; 95 % CI, 1.22-1.49) were more likely to code for complex cataract surgery. A high-volume ophthalmologist is less likely to write code for complex cataract surgery than a low-volume ophthalmologist. Conclusions There are significant differences among ophthalmologists in complex cataract surgery.
