Neurology & Pain Management Coding Alert

Question: Would you explain the -physician supervision of diagnostic services- section of Medicare's Fee Schedule?

New Hampshire Subscriber

Answer: The Medicare Fee Schedule supervision indicators show the level of physician supervision required for a diagnostic test if it's performed in a physician office, imaging center, or independent diagnostic facility (IDTF). Important: These rules don't apply to diagnostic tests performed in an inpatient or outpatient hospital setting.
 
Level 01 is general supervision. The physician provides overall direction and control, but the service doesn't require the physician's presence during the procedure. Examples of services requiring general supervision include sleep testing 95805 and 95808, and electroencephalography (EEG) procedures 95812 and 95819.
 
Level 02 is direct supervision. The physician must be present in the office suite and immediately available to furnish assistance and direction. The physician does not have to be in the room where the technician performs the test, however. Examples of procedures requiring direct supervision include autonomic function testing (95921) and EEG during nonintracranial surgery (95955).
 
Level 03 is personal supervision. The physician must be in attendance in the room during the procedure. Examples of procedures that require personal supervision include ischemic limb exercise testing (95875) and Wada activation test for hemispheric function (95958).
 
Level 09 is -concept does not apply.-
 
Protect yourself: Check payer policy information, CPT guidelines, and fee schedule data to determine what level of supervision your payer requires for each code.
 
-- Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.