Ophthalmology and Optometry Coding Alert

Question: Would you explain the “physician supervision of diagnostic services” section of Medicare’s Fee Schedule?

New Hampshire Subscriber Answer: The Medicare Fee Schedule supervision indicators show the level of physician supervision required for a diagnostic test if it’s performed in an ophthalmologist’s office. Important: These rules don’t apply to diagnostic tests performed in an inpatient or outpatient hospital setting.
 
Level 01: General supervision. The procedure is furnished under the physician’s overall direction and control, but the service doesn’t require the physician’s presence during the procedure. These procedures have a general supervision requirement:
 
• 92060 -- Sensorimotor examination
 
• 92065 -- Orthoptic and/or pleoptic training
 
• 92081-92083 -- Visual field examinations
 
• 92135 -- Scanning computerized ophthalmic diagnostic imaging
 
• 92250 -- Fundus photography

• 92270 -- Electro-oculography
  
• 92275 -- Electroretinography
 
• 92283 -- Color vision examination, extended
 
• 92284 -- Dark adaptation examination
 
• 92285 -- External ocular photography
 
• 92286 -- Special anterior segment photography. Level 02: Direct supervision. The physician must be present in the office suite and immediately available to furnish assistance and direction. The physician does not have to be in the room where the test is being performed, however. Tests requiring direct supervision include:
 
• 92235 -- Fluorescein angiography
 
• 92240 -- Indocyanine-green angiography. Level 03: Personal supervision. The physician must be in attendance in the room during the procedure. Among the ophthalmology codes, only 92265 (Needle oculoelectromyography, one or more extraocular muscles, one or both eyes, with interpretation and report) now requires personal supervision Level 09: Concept does not apply.
 
Protect yourself: Check payer policy information, CPT guidelines, and fee schedule data to determine which level of supervision your payer requires for each code.