Ophthalmology and Optometry Coding Alert

I have free time on weekends and would like to do ophthalmological exams in some local nursing homes, writes J. Daniel Carpenter, MD, an ophthalmologist in Cranberry Township, PA. What would be the proper and maximal way to code for doing exams in a nursing home?

For an answer, we talked to Nicole Marshall, billing manager for Scott and Christie and Associates, a two-ophthalmologist, one-optometrist practice in Pittsburgh, PA. For most of the nursing homes the doctors go to, Marshall uses 99261, 99262, or 99263the follow-up inpatient consultation codes. There are a lot of primary care providers in the area who ask us to go to nursing homes to see their patients, says Marshall.

These follow-up inpatient consultation codes actually have two uses: (1) to complete the initial consultation, or (2) subsequent consultations requested by the attending physician. But the key is that there must be an attending physician who is requesting the consultation, and the ophthalmologist must report to this attending physician. Usually we leave a report in the patients chart, says Marshall.

The follow-up inpatient consultation codes include monitoring progress, recommending management modifications, or advising of a new plan of care in response to changes in the patients status, according to CPT. These codes are for follow-up consults provided to either hospital inpatients or to nursing home residents. (See box in next column for follow-up inpatient consultation codes.)

Note that you can also use the initial inpatient consultation codes (99251, 99252, 99253, 99254, and 99255) the first time you see a patient in the nursing home. These codes are for use whether the patient is new or established, but you may only use an initial consultation code once per admission. Also, like the follow-up inpatient consultation codes, these codes are for hospital inpatients as well as for residents of nursing facilities. (See box in next column for initial inpatient consultation codes.) Once again, the key is that you must have a request from another provider for the consultation, and you must make a report to that provider.

Clinic-Type Situations

Sometimes, however, its hard to find an attending physician. This is the case with an institution which Marshalls ophthalmologists go to once a month. The facility used to be a nursing home, but now has many different kinds of patients, many of whom are severely mentally disturbed. There isnt an attending physician, so were not using the inpatient consultation codes for these visits, says Marshall. Instead, were using 99311, 99312, and 99313. These codes are for subsequent nursing facility care. (For a list of codes and their definitions, see box on this page.) These codes are specifically for residents of nursing facilities. All codes are reported on a per-day basis.

The doctor [...]