Ophthalmology and Optometry Coding Alert

Their services can boost the E/M level -  if they're following the incident-to rules Although technicians are worth their weight in gold in any ophthalmology practice, reporting their services can sometimes cause headaches for coders. But coding technicians' services - and recapturing potentially lost revenue - is as easy as knowing a few Medicare rules. 
 
Let the answers to these frequently asked questions guide you toward more effective incident-to coding. Question: Our tech often performs visual acuity and intraocular pressure tests during patient exams. Since the ophthalmologist is not performing those tests, can he include them in the exam level list to determine an E/M level? Answer: Yes - as long as your tech is meeting the "incident-to" requirements. The technician must be an employee of the physician practice, and the physician must either be involved in the service that day or have initiated care of the patient, made a plan of care and remained involved in the patient's care.
 
The technician must also meet the supervision requirements. The Medicare Carriers Manual limits incident-to coverage to "situations in which there is direct personal physician supervision." "The physician does need to be in the office" for you to be able to code for incident-to services, says Christina Hollis, OCS, coder and surgery scheduler at Pediatric Ophthalmology Associates in Columbus, Ohio. The physician must be present in the office suite and immediately available to provide assistance and direction, Hollis says.
 
Exception: In a group practice in which all of the physicians bill under the same tax ID, "as long as one of the other doctors is physically in the office, then you can bill for [incident-to services]," Hollis says.
 
Example: The tech performs visual acuity and IOP tests on an established patient. The ophthalmologist tests visual fields and ocular motility, and performs slit lamp exams of the patient's corneas, lenses and anterior chambers. The ophthalmologist made medical decisions of low complexity.
 
Since the ophthalmologist and the tech performed a total of seven tests, the exam portion of the E/M service qualifies as "expanded problem-focused." That and the low-complexity MDM qualify the service for 99213 (Office or other outpatient visit for the evaluation and management of an established patient...).
 
Watch out: Local coverage determinations may differ in the number of tests required to reach a certain E/M or eye code (92002-92014) level. Check your LCD for specific requirements.
 
Hidden trap: Don't assume that the tech's write-up of the history of present illness (HPI) will help boost your E/M level. According to Medicare E/M coding guidelines, the physician or NPP reporting the service must obtain the HPI. If the tech takes the HPI, the physician or NPP must clearly show agreement and review of the HPI as documented by [...]