Ophthalmology and Optometry Coding Alert

Question: If one of our techs handles a visual acuity tests or IOPs incident-to, can these be applied to the elements or bullets in the examination portion of the 1997 E/M documentation guidelines?

New Hampshire subscriber

Answer: Yes, you can apply the elements above to the elements of the exam as per the 1997 guidelines, if the activities of the tech (as documented in the patient record) meet all of the Medicare Carriers Manual's requirements for services billed incident to.
 
Medicare defines "incident to" as "services or supplies furnished as an integral, although incidental, part of the physician's personal professional services in the course of a diagnosis or treatment of an injury or illness."
 Medicare also provides some general guidelines that help qualify the service provided as being incident to. They include:
 
1. Incident to services must be an integral part of the physician's professional service. The emphasis here is that the tech performs these services as a part of the physician's treatment - not that the tech performs these services as a substitute for the physician. The physician must be involved with the patient's care, including the physician seeing and establishing the course of treatment for the patient.
 
2. The tech must be under the physician's direct supervision while delivering care. This does not mean the physician must watch over the tech's shoulder, nor does it mean that she needs to be in the room where the test is taking place. The physician must be physically in the facility while the test is taking place. (At the other end of a phone line does not count.)
 
Make sure that the physician signs off on any additional documentation that you keep with the patient files. By initialing off on the procedures, the physician is demonstrating that she has reviewed these components of that exam.
 
3. The same organization has to employ both the tech and the doctor report services "incident to." If the ophthalmologist owns the practice, then the practice must give the tech a W-2 form.
 
If conditions meet the guidelines above, then the tech can perform these tests incident to and report them under the ophthalmologist's PIN. Be advised of the guidelines above, though, as the OIG has once again stated that in 2003 incident to is on their shortlist of office infractions they will be scrutinizing.