Ophthalmology and Optometry Coding Alert

An ophthalmologist may want to see fundus photos or A-scans on a regular basis. To have a standing order in the chart for such procedures is not acceptable. Standing orders for services like fundus photos or A-scans do not pass inspection by Medicare, explained Lise Roberts, vice president of Health Care Compliance Strategies, a coding and compliance consultant based in Jericho, N.Y., in a recent audioconference sponsored by The Coding Institute. What Medicare does expect is that every test performed will have an individual order.

Also, if the treatment plan indicates cataract surgery, dont assume that also includes A-scans (e.g., 75619, ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation). If you want A-scans, you need to say so specifically. Everybody just sort of knows that [the A-scan] is going to happen, says Roberts. That would be considered a standing order in the absence of a specific order for that patient.

Remember, standing orders are not allowed. If you dont have an individual order for that patient, then Medicare considers the test unreasonable and unnecessary, adds Roberts.