4. Is the provider specialty 18 ophthalmology or (KY) 41 Optometrist?
5. Medical history and physical examination completed and documented by the ordering provider as it relates to the complaint of the patient for that visit?
Yes No
6. Is a comprehensive ophthalomologic exam present?
Yes No
7. Is an operative report present?
Yes No
8. Is there an ophthalmic biometry?
Yes No
9. Does the documentation support the procedure billed as medically necessary?
Yes No
Physician documentation specifying rationale