Ophthalmology and Optometry Coding Alert

HCFA published new supervision rules in 1997, but the rules were put on hold in 1998. On April 19, 2001, HCFA published a program memorandum revising and implementing these rules, which will be effective July 1.

The following is a summary of the rules from Raequell Duran, president of Practice Solutions, an ophthalmology coding and compliance consultancy based in Santa Barbara, Calif.

Under the rules, three levels of supervision are identified:

1. General: Means the procedure is furnished under the physicians overall direction and control, but the physicians presence is not required during the performance of the procedure. Codes 76536 (echography), 92060-92065, 92081-92083, 92135 (special ophthalmological services), 92250 (ophthalmoscopy) and 92283-92284 (other specialized services) are identified under this category. (This means that it will no longer be required to have a physician of the group on site during the performance of the tests listed above.)

2. Direct: In the office setting means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed. CPT codes 76506, 76516-76529 (diagnostic ultrasound), 92235-92240 (ophthalmoscopy) and 92285 (other specialized services) are listed under this category.

3. Personal: Means the physician must be in the room during the performance of the procedure. Codes 76511-76513 (diagnostic ultrasound), 92265-92275 and 92286 (other specialized services) are listed under this category.