Primary Care Coding Alert

Question: Our carrier asked us to verify that our nurse performed a patient's stress test under direct supervision from the doctor. What does this mean?

Alaska Subscriber Answer: The Medicare Physician Fee Schedule supervision indicators show the physician supervision level required for a diagnostic test if it's performed in a physician office, imaging center, or independent diagnostic testing facility (IDTF). Important: These rules don't apply to diagnostic tests performed in an inpatient or outpatient hospital setting.

First, you must understand each level of supervision, because the Fee Schedule lists them in number format (such as 01, 02, and so on). You can find explanations of the supervision levels in Medicare-s IOM 100-02 Medicare Benefit Policy Manual, Chapter 15, Section 80.  

The following levels apply to family physicians:

Level 0 or 09: Procedures listed in these categories are not subject to the supervision requirements.

Level 01 refers to general supervision. What this means: The physician must provide direction and control during the procedure, but the physician's presence is not required during the performance of the procedure. For example, most payers only require general supervision during plain x-ray films.

Level 02 is direct supervision. What this means: The physician must be present in the office suite and immediately available to furnish assistance and direction, but the physician does not have to be in the room where the patient undergoes the test. Examples of procedures requiring direct supervision include cardiovascular stress tests (93015-93017), allergy tests (such as 95024-95056) and nebulizer demonstration (94664, Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device).

 Level 03 is personal supervision. What this means: The physician must be in attendance in the room during the procedure. For example, you must perform a stereotactic breast biopsy (77031) under personal supervision.