Ophthalmology and Optometry Coding Alert

Question: Our technician performed a visual acuity test on a Medicare patient as a follow-up service for an amblyopia. How should I code this?

North Carolina Subscriber

Answer: When a service is provided to a Medicare patient without physician presence, you have to determine whether the "incident-to" requirements have been met. Let's look at some of the basics of incident-to billing:

Services or supplies that are furnished as an integral, but incidental, part of the physician's personal professional services in the course of diagnosis or treatment of a patient are called "incident-to."

Coverage of services and supplies incident-to the professional services of a physician in private practice is limited to situations in which there is direct personal physician supervision. This applies to services of auxiliary personnel employed by the physician and working under his or her supervision, such as nurses, nonphysician anesthesists, psychologists, technicians, therapists including physical therapists and other aides.

So when a physician employs auxiliary personnel to assist him or her in rendering services to patients and includes the charges for their services in his or her own bills, the services of such personnel are considered incident-to the physician's service if: 1) there is a physician's service rendered to which the services of such personnel are an incidental part, and 2) there is direct personal supervision by the physician.

This does not mean, however, that each service by a nonphysician (or the furnishing of a supply) always needs to be on the occasion of the actual rendition of a personal professional service by the physician. Such a service or supply could be considered incident-to when furnished during a course of treatment where the physician performs an initial service and subsequent services of a frequency that reflects his or her active participation in and management of the course of treatment. However, the direct personal supervision requirement must still be met with respect to every nonphysician service.

Direct personal supervision in the office setting does not mean that the physician must be present in the same room with his or her aide. However, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the aide is performing services.

If the reason the patient was being seen was medically necessary, ordered by the physician in the chart, and the outlined incident-to requirements were met, you could bill the technician work with 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services).

Answers to You Be the Coder and Reader Questions provided by Marianne F. Wink, RHIT, compliance analyst/educator with Strong Health Compliance Office in Rochester, N.Y.; and Raequell Duran, president, Practice Solutions, Santa Barbara, Calif.