Ophthalmology and Optometry Coding Alert

If you believe your technician's only purpose is to save extra time for the physician, you may be losing out on some valuable reimbursement.

Technicians in ophthalmology practices perform a variety of services that ultimately save the physician valuable time. However, technicians differ from regular nonphysician practitioners (such as PAs, NPs, and NAs) because they are not licensed by the state, says Tammy Harmon, CPC, who works at Atlantic Ophthalmology in Beaufort, S.C. They can receive certifications, such as a certified ophthalmic assistant (COA), certified ophthalmic technician (COT), and several other certifications through the Joint Commission on Allied Health Professionals Organization, but they do not have their own provider identification number (PIN). Therefore, you always have to bill incident-to a physician's service when reporting technician services.

Questions arise regarding how to bill for specific services that technicians provide. You may be surprised to find out that you're not getting the most out of your technician's time. Take a look at the following questions and test your knowledge to find out whether you make the grade for technician billing know-how.

The most important thing for you to remember is that the technician's services must meet Medicare's requirements for incident-to billing. According to the Medicare Carriers Manual, the services furnished must be an integral, although incidental, part of the physician's personal professional services in the course of diagnosis or treatment of an injury or illness.

Services are included incident-to when a physician supervises technicians who assist him in rendering services to patients and includes the charges for their services in his own bill. However, this does not mean that each service rendered by a technician must always be on the occasion of personal professional services by the physician. Services are incident-to when furnished during a course of treatment when the physician performs an initial service and subsequent services to reflect his active participation in the course of treatment.

The kicker concerns direct supervision. Medicare requires that a physician from the practice be present in the office suite and immediately available to provide assistance during the service.

Under the above circumstances, you cannot report 76519, since the physician is not in the office suite. Medicare policy states that while a diagnostic testing service can be performed as an incident-to service, it must also meet the supervision requirements specific to diagnostic test benefits, which may be higher than the level of direct supervision.

Technicians often see patients before their office visit. According to Marcia Porter, CPC, CHCC, who codes for an ophthalmology practice in Charleston, S.C., technicians at her office take the patients back, take their history and complaint, test for glaucoma, refract, read their glasses, and administer drops. Some also perform various screening procedures, such as visual acuity, confronta-tional visual field, ocular motility, pupillary reaction, intraocular pressure, and split-lamp examinations.

You should take these services into account when determining the level of E/M services you bill for. These services can increase the level of the office visit, Porter says. After the technician sees the patient, the ophthalmologist finalizes the examination by reviewing the medical history and asking any pertinent questions, checking vision, and sometimes double-checking pressure.

Whether you report an E/M code (99201-99215) or an eye code (92002-92014), it should encompass all services provided because you have met the incident-to requirements and the technician's work is an integral part of the physician's service.

CPT defines one low-level E/M service code as an "Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician." This code is 99211 and is commonly referred to as a "tech check." Incident-to still applies here, since Medicare covers services provided during a course of treatment in which the physician performs the initial service and subsequent services to reflect his participation in the course of treatment. The doctor does not have to participate during the visit. Porter says she bills 99211 when the patient comes in for rechecks, which the technician performs.

The key to billing a tech check is documentation. You have to establish medical necessity in order to bill any service to the Medicare program, and many practices fail to do this. Take a look at the following examples: