Our practice employs orthoptists that are always under the supervision of a pediatric ophthalmologist. Can they bill an office visit if they are under the supervision of a physician? Secondly, can they bill CPT code 92066 and 92060 the same day?

Answer:
Although they are highly trained, orthoptists are not licensed practitioners. They may bill CPT code 99211 Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician or other qualified health care professional when appropriate and 92066 Orthoptic training; under supervision of a physician or other qualified health care professional when ordered by a physician. Correct billing of CPT code 99211 is covered in Fundamentals of Ophthalmic Coding.

For CPT code 92066, services must have a documented order from the ophthalmologist that outlines the diagnosis, treatment plan and reevaluation needs. An orthoptist or technician would render these services per the initial orders written by the physician. Notation in the medical record should include an assessment of each visit. As with all services, payers may have frequent edits for coverage. If no other separately identifiable service is performed at the same time, an evaluation and management (E/M) service would not be coded.

There are no CCI edits for CPT codes 92066 and 92060, sensorimotor exam. When billing 92060, supporting documentation must include multiple measurements of ocular deviation along with the findings interpreted and reported.

Visit Pediatrics and review the Coding Assistant: Pediatrics/Strabismus for additional coding and reimbursement guidance.