Ophthalmology and Optometry Coding Alert

An ophthalmologist (who would like to remain anonymous) is on staff at a hospital with a resident training program. That physician tells us she is required to help train residents. The patients she sees are not hers; they are going to the resident clinic, and although the training physician is supervising, only the residents see and examine the patients. How can the ophthalmologist get paid for providing this training?

For example, lets say a visual field is done on a patient. The technician does the visual field, and the ophthalmologist does the interpretation -- explaining the interpretation to the residents. And lets say Medicaid is paying $15 for these interpretations. The ophthalmologist asks, Is there any way I can capture more income? And also, Does my interpretation have to be dictated, or just documented in the chart?

For an answer, we talked to Gregory L. Schnitzer, RN, CPC, audit specialist with the office of audit and compliance at the University of Pennsylvania, which has learned its lesson when it comes to residents (the hospital paid $30 million in fines for billing for services that the residents had participated in).

The way its supposed to work is that since physicians are performing tasks above and beyond their usual work when they train residents, they should be getting some small stipend from the hospital, says Schnitzer. And Medicare pays the hospital a bit more than normal, to cover this. If the hospital is not paying you some small stipend, you should enter into a contract for such a fee, says Schnitzer.

But the audit specialist stresses that the extra fees from training residents have nothing to do with billing. There is no modifier for training, he says. Thats in a separate pot from billing; the hospital is supposed to be handling the money for training.

Finally, dictation is preferable to notes in the chart, says Schnitzer. That way, if there are any gray areas, you can say, I really did this, he says. However, there is no dictation requirement for visual fields. You are only required to write down your findings in the progress notes.