Ophthalmology and Optometry Coding Alert

Question: An optometrist in our practice refers patients to the ophthalmologist, also in the practice, for certain conditions that need surgery, such as cataracts. Can we bill the first ophthalmologist encounter as a consultation?

Connecticut Subscriber

Answer: The revised (as of August 1999) Medicare language for consultations makes it very clear that intra-office consultations are allowed, but states that all requirements of the consult policy must be met. One very specific statement is that a written report must be sent. The previous policy referenced that the consulting physician must communicate his or her opinion, which could have been done by sharing a common chart. Since the new language does reference a written report, it is best that your chart contain a specific report from the consulting physician to the referring physician. The policy does not specify length or required context, but it is a
safer practice to have some form of written report in the record that could be sent to the carrier upon their request. Document the request for the consultation and the reason for the consultation in the record.

Note: For the relevant excerpt from transmittal number 1644 of the Medicare Carriers Manual, section 15506, go to: codinginstitute.com/news/article2.html.