Ophthalmology and Optometry Coding Alert

Question: One of our surgeons performed laser surgery on a patient, and then went on vacation. The patient came in during the post-op period complaining of floaters and saw the on-call doctor. The on-call doctor is billing the patient for the visit stating that he is not on the patient's insurance. He insists that the post-op period only applies to the surgeon, not him, even though the floaters were related to the surgery. Can he do this?

Georgia Subscriber

Answer: No, he can't. The CPT manual specifically states in the Evaluation and Management Services Guidelines section (preceding Chapter 1): "In the instance where a physician is on-call for or covering for another physician, the patient's encounter will be classified as it would have been by the physician who is not available." Therefore, it would be incorrect to bill for an office visit performed by the on-call physician during the post-op, because the covering on-call physician is, indeed, subject to the same guidelines as the physician he is covering. 

If this had been a problem unrelated to the original surgery, then the on-call physician would be able to bill the office visit for an established patient with modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) and an unrelated diagnosis code.