Ophthalmology and Optometry Coding Alert

Don't let AMA's typos trick you into reporting the wrong 'new patient' codes

If you're using the charts and tables in the E/M guidelines in the CPT manual to help you assign codes for ophthalmologists' visits to rest homes, watch out. An error in one table could get your claim denied.

The AMA released corrections to the 2006 CPT manual, listing potentially confusing errors in your coding book.

Table 1, found in the "Evaluation and Management Services Guidelines" section preceding the listing of E/M codes, shows the wrong set of codes to report for a new patient evaluation in a domiciliary, rest home or custodial care facility. The table mistakenly directs you to report 99307-99310 (Subsequent nursing facility care, per day, for the evaluation and management of a patient...) instead of 99324-99328 (Domiciliary or rest home visit for the evaluation and management of a new patient...).

Fix it: To head off possible miscoding, mark the new codes in your CPT manual:

CPT and Medicare define a rest home, domiciliary or custodial care facility (place-of-service code 33) as a facility that "provides room, board and other personal assistance services, generally on a long-term basis." Such facilities do not have a medical component, which distinguishes them from a nursing facility (POS 32).

Do this: To see the complete list of errors for the CPT 2006 manual, visit http://www.ama-assn.org/ama/pub/category/print/3896.html.

Note: For more information on coding ophthalmologists' visits to rest homes, see "Relax--Rest Home Coding Is Easier Than You Think" in the February 2006 Ophthalmology Coding Alert.