Ophthalmology and Optometry Coding Alert

Ophthalmologists and optometrists, in association with their respective eye-care groups, make monthly or semimonthly professional visits to a variety of nursing facilities. Coding these visits depends on the services performed and the type of nursing facility in which the patient resides.
 
In most cases, an optometrist goes to a nursing home to conduct routine exams; an ophthalmologist or subspecialist will visit a facility only if a patient requires medical attention. The purpose of the visit determines the code selection, not which professional performed the service.
 
The ophthalmologist and optometrist may choose one of the following codes: nursing facility (99301-99313), domiciliary (99321-99333), eye (92002-92014) or outpatient services (99201-99215). Inpatient codes for nursing-facility visits may be used only if the nursing facility is an acute-care facility within a hospital. 
 
There are two kinds of nursing-facility services (99301-99313) and domiciliary, rest-home or custodial-care services (99321-99333). The nursing-facility codes are for services provided within a facility in which 24-hour medical services are available. Domiciliary, rest-home and custodial-care codes are for nursing homes that provide room and board, as well as personal assistance. Domiciliary codes are used only when the nursing facility does not provide medical assistance to its residents.
What Constitutes a Routine Eye Visit?  
The nursing-facility medical director or nursing staff identifies patients with chronic conditions that require regular monitoring for routine eye visits. For example, a visit would be considered routine if a glaucoma patient who is managed by medication needs to be seen every four to six months or if a patient with slowly progressing cataracts needs to be seen only once a year.
 
In these instances, code selection depends on which type of service the ophthalmologist or optometrist performs. Professional services are also contingent upon the type of medical equipment available at the nursing facility. For instance, if the nursing facility does not own a slit lamp and, as a result, an anterior segment examination cannot be performed, lower-level exams may be appropriate. If the nursing facility owns a slit lamp or if the ophthalmologist or optometrist brings his or her own equipment to the nursing facility (e.g., slit lamp, funduscope or an indirect ophthalmoscope), higher-level exams can be billed.
 
"Code what is being done," says Lise Roberts, vice president of Health Care Compliance Strategies, a company based in Jericho, N.Y., that develops interactive compliance training courses. In the past, eye codes have required less documentation than E/M codes, but this is not necessarily true for the exam, Roberts says. Some carriers' local medical review policies (LMRPs) for eye codes are quite prescriptive about what is required in the exam.
Low-Level Eye Codes  
Rather than using nursing-facility codes for routine visits, coders use the low-level eye codes 92002 (ophthalmological services: medical examination and [...]