Optometry Coding & Billing Alert

Question: Should I use a modifier when reporting services provided incident-to the optometrist's care?


Utah Subscriber


Answer: No, you don't have to append a modifier of any type to identify incident-to services. Rather, you should report incident-to services just as if the physician performed the service himself. When billing incident-to services, however, you should keep in mind these three facts:

- To bill a service incident-to, you need direct physician supervision, which requires the physician to be immediately available in the office suite. To document this, you need at least a simple phrase in the progress notes such as -Performed under the supervision of Dr. X- or -Service provided under the supervision of Dr. X.-

 Failing to document physician supervision could lead to a government audit. And even though your physicians may be able to show the auditors their schedules and prove that they were in the office at the time, it's still a time-consuming--and therefore costly--hassle that you can easily avoid with better documentation.

- You cannot bill incident-to services for new patients or for established patients with new problems. Rather, to report a technician's services incident-to a physician, you must provide the services to an established patient with an established plan of care.

- All services the technician provides must be within the technician's scope of practice as defined by your state, and the technician must be an employee of the physician or practice.