Tuesday, February 22, 2011

Medical Coding - Office Visit With Vision Training?

Can you submit 99213 for an office visit and 92065 for vision training on the same date of service (DOS)?

Well, vision training code 92065 (Orthoptic and/or pleoptic training, with continuing medical direction and evaluation) is not bundled with E/M code 99213 (Office or other outpatient visit for the evaluation and management of an established patient …).

Remember: There must be medical necessity for providing the E/M service and documentation should be separately identifiable in the medical record to support the need and level of service. Some carriers or private payers may require the use of modifier 25 (Significant, separately identifiable E&M service. The office must be able to stand alone as a procedure without the vision training session; as such ask yourself: “Would 99213 have been required even if the 92065 procedure had not been done?"

But then note that 92065 is bundled with 99211 (Office or other outpatient visit for the E&M of an established patient, that may not require the presence of a physician …).

What's more, include the recommendations or prescription from the referring physician for the vision training (92065) in addition to documentation in the medical record to support the medical necessity for the office visit (99213). The vision training can be done under general supervision by a technician; however the physician must perform the OV.

Documentation of the training by a technician must also support direction and oversight by the physician. The claim should also show the referring physician's name (which may be the actual physician submitting the charge.)

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