Ophthalmology and Optometry Coding Alert

Question: We've been performing glaucoma screenings on Medicare patients at our office, but our administrator recently told us that these services have supervision requirements, and sometimes the nurses are performing the service while the physicians aren't there. The nurses said they can perform this without restriction. Who is right?

Codify Subscriber

Answer: The administrator is right. To qualify for the glaucoma screening under CMS rules, the services must be furnished by an optometrist or an ophthalmologist, or furnished under the direct supervision of an ophthalmologist or optometrist. Direct supervision means the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure.

Bottom line: If the doctor is out to lunch, on vacation, out sick, or otherwise not available in the office suite, you cannot report a service as if it was furnished under the doctor's direct supervision.