Ophthalmology and Optometry Coding Alert

Remember the 3 R's: Request, render and report

Before you report consult services 99241-99263, your documentation must show that the service meets three basic requirements, says Raequell Duran, president of Practice Solutions in Santa Barbara, Calif.:

1. A physician or other appropriate source must request the consultation, and the reason for the request must establish medical necessity for the consulting physician to visit the patient. Either the requesting physician or the consulting physician must record the request in his documentation, Duran says.

2. The consulting physician must document his visit with the patient and render advice or an opinion regarding the management of the patient's condition.

3. The consulting physician must prepare a written report of his findings and provide them to the requesting/referring physician (the consulting physician can record this information in the shared patient record for inpatient consultations).

Rules 1 and 3, however, do not apply to confirmatory consults (99271-99275, Confirmatory consultation for a new or established patient ...). For these services, the request can come from the patient, insurer or other source, and the consulting physician need only provide an opinion on the patient's condition. CPT 2006 may delete codes 99271-99275 (see "CPT Consolidates Consult Coding for New Year" included with this issue).

Remember: A consulting physician may initiate treatment and/or provide diagnostic testing and still report a consult. If, however, the physician accepts primary responsibility for the patient prior to the visit, a transfer of care has occurred, and you should report a new or established patient visit, depending on the situation and setting.