Otolaryngology Coding Alert

Question: A patient visits the otolaryngologists office for weekly allergy injections that are performed by a nurse without a provider number of her own. The patients regular physician is performing surgery, but another physician is present. Under whose name should the service be billed?

Florida Subscriber

 
Answer: The claim must be reported in the name of the otolaryngologist (or another physician) who was in the office suite at the time of the injection. Billing an incident to service in the name of a physician who is not present is considered fraudulent. The incident to guidelines in Medicare Carriers Manual (MCM) Section 2050 clearly state that direct personal supervision by a physician is required for a service to be billed incident to. The MCM defines direct personal supervision as follows: Direct personal supervision in the office setting does not mean that the physician must be present in the same room with his or her aide. However, the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the aide is performing services. Since only the physician in the office can provide direct personal supervision in this case, the claim for 95115 (professional services for allergen immunotherapy not including provision of allergenic extracts; single injection) or 95117 ( two or more injections) must be filed in that physicians name, regardless of whose patient was treated.