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Posted By Amanda on 06-03-2002, 13:02:00 in Ophthalmology
A patient came in complaining of her peripheral vision being fuzzy. The
doctor ordered a visual field being not sure what was wrong or going on and
the visual field came back normal.

Can we bill with either 368.40 or 368.44?

Comments (5)
Posted By Amanda on 06-19-2002, 12:05:00
So should we do them or not?

Posted By Amanda on 06-13-2002, 13:02:00
Well now I don't know what to do? Has anyone else done a visual field for a
doctor outside of your clinic?

Posted By douglas on 06-12-2002, 22:50:00
I refrained from answering because I really don't think there is a clean
answer to the question posed by Amanda. However, I don't think you can
really bill "incident to" on patients not in your own practice. One of the
"incident to" rules is that the doctor saw the patient and that obtaining
the test was part of his management plan. The test is thus performed as
part of (that is, "incident to") his evaluation and management of the
patient's problem. That's the fundamental concept of "incident to".

By the way, the supervision rules for "incident to" services used to require
a supervising doctor on site, but now they have changed that, and in the
case of visual fields he can be off site. But for some other tests, he must
actually be in the room. They now define three levels of supervision and
designate which tests are in each category: general (off site, but
responsible), direct (on site) and personal (in the room, "over the

If you are doing a field test for another doctor, you could provide as part
of the service the interpretation, and bill globally rather than just the
-TC component, with the assumption that the doctor with the staff and
equipment is likely better qualified to interpret the test than the doctor
who does not have the capability of doing the test in his own office.

Having said (written) all that, I actually don't know how to provide this
service or bill for it. I have not been able to determine in studying this
kind of situation over the last several years whether you have to be a
properly credentialed independent diagnostic entity (like clinical
laboratories and independent radiologists do) in order to provide this kind
of service, much less bill for it.

Common sense says that the patients are well served if a physician with
infrequent need for visual field testing depends on a colleague to provide
this diagnostic service. I would think, as mentioned, that it would be best
for the office providing the technical service also to provide the
interpretation. And it's picky, but I just worry that somewhere there's a
technicality that says you can't provide diagnostic testing at all except on
your own patients ("incident to" your own management) unless you have some
kind of license as a diagnostic center, although I suspect it is such an
infrequent occurrence that no explicit statement exists in all the
government's documents that covers visual fields. That means you just have
to do what is best for the patient, bill fairly, and hope that any auditor
will exercise common sense in a situation that doesn't seem to have a
defined set of rules. If you are going to do it at all, I would think that
the doctor should do the interpretation and simply bill under his own name.
An alternative is to offer the service only in the context that the doctor
provides some low level consultation (sending doctor asks for opinion of
status of glaucoma), with sufficient E/M components and elements that he can
say a field is necessary (history, pressure, look at the disc), interpret
the field, and bill a low level consultation and globally for fields
incident to the consultation. Consultative letter provides an evaluation of
the severity of glaucoma on the basis of history and exam, and the status of
the fields, to assist a colleague who hasn't the office equipment to do that
level of evaluation, so consultation is medically reasonable and necessary.
Or get into some kind of co-management situation.

Well, those are some ideas. I suppose what is best for the patient's care
depends on details of the involved physicians, the community standards, etc.

Douglas R. Anderson
Posted By Amanda on 06-12-2002, 15:08:00
How would you report a visual field when an outside doctor requested it?

I know that we need to use modifier TC because all we did is the test but
would you use the doctor that requested the field as the ref dr?

Usually we bill incident to and use the doctors name as the doctor that did
it and also the ref dr.

Should we just pick a doctor to bill under and then use the requesting
doctors name in the ref dr spot?


Posted By michael on 06-08-2002, 15:05:00

In a message dated 6/3/02 11:33:34 AM, writes:

<< -- MsgId= 102496--

> A patient came in complaining of her peripheral vision being fuzzy. The

> doctor ordered a visual field being not sure what was wrong or going on


> the visual field came back normal.


> Can we bill with either 368.40 or 368.44?


> Amanda >>

I might use the symptom thatjustifies the test: 368.8

Dr. Yaros
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