Cardiology Coding Alert

Learn what to do when another provider does supervision Supervision levels can make or break your claim, so you have to know what supervision level your cardio procedures require -- or you could face denials.
 
If the nurse practitioners in your office perform SPECT studies, you know that they generally include a stress test that demands direct supervision -- a potential problem for payers. Keeping track of what Medicare defines as supervision in cases like these, let alone what tests require what levels of supervision, can be daunting.

Not following Medicare's rules for diagnostic test supervision may lead to claim denials. CMS' policy states that certain diagnostic tests must be supervised "to be considered reasonable and necessary and, therefore, covered under Medicare."

Follow these three expert steps, and you'll be certain your claims are rock-solid and reimbursement is on its way. Step 1: Perfect These Supervision Basics First, you must understand each level of supervision.

Where to find them: 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.

You have three supervision indicators to learn: 01, 02 and 03.

General: Level 01 is general supervision. What this means: The physician must provide direction and control during the procedure, but the service doesn't require the physician's presence. For example, most payers only require general supervision during plain films, most ultrasounds, and CT or MRI without contrast.

Direct: 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. "Most conferences and seminars I've been to tell us to refer to this as 'hollering distance.' If you can call for help and the physician can hear you, this qualifies," says Sandy Fuller, CPC, compliance officer at Cardiovascular Associates of East Texas in Tyler.

Examples of procedures requiring direct supervision include exams using intravenous contrast, cardiovascular stress tests and pacer monitoring, with the exception of antitachycardia pacemaker interrogations (93724, Electronic analysis of antitachycardia pacemaker system [includes electrocardiographic recording, programming of device, induction and termination of tachycardia via implanted pacemaker, and interpretation of recordings]). Code 93724 has a technical component that requires personal supervision.

Personal: Level 03 is personal supervision. What this means: The physician must be in attendance in the room during the procedure. Examples include heart catheterizations, transesophageal echocardiograms and 93724. Step 2: Erase Blurred Lines for Good Determining supervision levels may seem clear-cut, but you may find that procedures are sometimes [...]