Ophthalmology and Optometry Coding Alert

Question: What level of physician supervision is now required by HCFA for an A-scan (76519)? Level-one, level-two, or level-three?

Vermont Subscriber

Answer: The final rule for the 1998 Physician Fee Schedule and Payment Policies for the Medicare Program were published in the Oct. 31, 1997, Federal Register.

Note: Although most of the final rule was implemented on Jan. 1, 1998, HCFA postponed implementation of the language relating to the supervision of testing services.

In a memorandum to all associate regional administrators dated Jan. 28, 1998, HCFA advised the carriers to continue to follow existing rules regarding testing.

The physician in the practice must be on-site and readily available to assist the non-physician performing the testing procedure. The final rule language created three different types of supervision relating to the performance of testing services. The three levels created were general, direct, and personal supervision. General supervision meant the procedure is furnished under the physicians overall direction and control, but the physicians presence is not required during the performance of the procedure.

Under general supervision the training of the non-physician personnel who actually perform the diagnostic procedure and the maintenance of the necessary equipment and supplies are the continuing responsibility of the physician. Direct supervision (which is the type of supervision required under the old, existing rules) means the physician is required to furnish assistance and direction throughout the performance of the procedure, but does not mean that the physician must be present in the room when the procedure is performed. Personal supervision meant a physician must be in attendance in the room during the performance of the procedure. To answer your question, 76519 (ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation) was listed as requiring personal supervision in the final rule, but since that has never been implemented, it is direct supervision that is still required.