Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist evaluated an established patient for dry eyes and offered her a sample of lubricant eye drops, but then realized he was out of stock. He told her to return the next day, which she did, and she picked up a small box of the drops. The doctor did not see her that day, but he billed a 99211 for the encounter. We don’t think that’s allowable. Can you advise?

Codify Subscriber

Answer: You are correct—unless there’s more to the story that you haven’t revealed, this visit does not qualify for a 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services …).

To bill a 99211, there has to be medical necessity, meaning a workup of some sort, and just handing the patient a box of eyedrops certainly doesn’t meet the requirements of that. You should only report 99211 in cases where the documentation shows that services meet the minimum requirements for an E/M visit. Picking up a prescription or medication samples does not suffice.