Orders for Diagnostic Testing – Ophthalmic Professional

Here’s a fairly common scenario for technicians: Mrs. Jones, a patient, has complaints of decreased vision that does not improve with a careful refraction. The technician reads the chart and, based on one of the patient’s previous diagnoses, “knows” the doctor will want an OCT of the retina.

Is this proper? Can the practice bill this test to insurance?

While knowledgeable about the patient’s possible disease, the technician is not licensed. As a result, she cannot order a test. Secondarily, if payers question the billing, they want to see that the test is properly ordered. Here, I’ll deal with the relevant citations and help with the example above. (Note that I won’t deal with the considerations on the “interpretation and report” [see tinyurl.com/OPCoding7171 ] or the “supervision rules” for diagnostic tests).

This article addresses the following topics regarding interpretation and report:

Medicare’s ruling
The best practice answer
Referral scenarios

This article was published in Ophthalmic Professional’s Coding column, and written by Corcoran’s Senior Consultant, Paul Larson, COE. To view the entire article in Ophthalmic Professional, click on the link below:


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