Ophthalmology and Optometry Coding Alert

Question: What level of supervision does 92083 (extended visual fields) require: level 1 (no supervision), level 2 (physician present in the office suite) or level 3 (direct physician contact)?

Vermont Subscriber

Answer: In November 1997, HCFA released new categories and definitions of types of supervision. The new types were to go into effect on Jan. 1, 1998. Specific CPT codes were assigned general, direct or personal supervision. General did not require physician presence, direct required the physician to be on-site and readily available, and personal required the physician to be in the room. The ruling was questioned due to old language that stated x-rays (not all diagnostic testing services as they had included in the final rule), and was never implemented at the carrier level. HCFA sent a memorandum to the carriers informing them not to implement the changes in the final rule published on supervision requirements. Without implementation of the new requirements, the established rules regarding incident to services are still in effect regarding supervision. In regard to visual field testing, it is still required that a physician of the group be on-site and immediately available during the performance of the service.