To avoid fraud and receive appropriate reimbursement,
ophthalmology coders must know when they can bill for technician services and when the services are incident to the physician. A technician works for an ophthalmologist in three main areas:
1. screening a patient for the physician,
2. performing a testing service, and
3. performing preoperative checks.
In this article, we will discuss whether these services are billable, and how to code them when they are.
Screening the patient for the physician is not separately billable from the service the physician provides. Before the ophthalmologist sees the patient, the technician obtains a medical and ocular history (interim if an established patient), and a chief complaint, and performs various screening procedures such as testing visual acuity, confrontational visual field, ocular motility, pupillary reaction, intraocular pressure and, in some practices, a slit-lamp examination. After the slit lamp has been performed by either the technician or physician, the technician dilates the patient, when appropriate. These screening procedures are not separately billable. The physician will see the patient, and the physicians code whether an evaluation and management (E/M) code or an eye code (92002-92014) will encompass the work done by the technician. This is because the technicians services fall under the Medicare incident to rule, which states that services performed by individuals employed by the physician are to be handled as incident to the physicians service and included in the physicians billing.
The technician is employed by the physician to provide assistance, explains Raequell Duran, president of Practice Solutions, an ophthalmology coding and compliance consulting company based in Santa Barbara, Calif. The physician is the one who renders the service. The technician documents the patients chief complaint, acquires a history and performs testing services; the physician completes the service. All of the work performed by the technician becomes billable work for the physician.
Technicians Are Considered Incident To
The ophthalmic technicians used by ophthalmologists differ from the nurse assistants who help in obstetricians offices because, for example, technicians are not licensed by the state, notes Lise Roberts, vice president of Health Care Compliance Strategies, a consulting and compliance consulting company based in Jericho, N.Y. Ophthalmic technicians may be certified through the joint Commission on Allied Health Professionals Organization, but they cannot receive Medicare or Medicaid provider numbers, universal provider identification numbers (UPINs) or provider identification numbers (PINs) for the purpose of billing because they are not licensed. This is true nationwide, Roberts says. All services of ophthalmic technicians must therefore be incident to a physicians service to count toward a physicians coding. Services of allied health professionals such as nurse practitioners (NPs) and physician assistants (PAs), who are licensed by the state [...]
