Ophthalmology and Optometry Coding Alert

Question: On his way home, our ophthalmologist visited an age-related macular degeneration (ARMD) patient at her home. She is bed-bound and was having flashes and floaters. How can he bill for that visit?

New York Subscriber

Answer: Code the appropriate level (depending on documentation) of the home-services codes for either a new patient (99341-99345) or an established patient (99347-99350).
 
The payer would consider this a medically necessary emergency, possibly signaling a retinal detachment. Even though the fee for a home visit is much higher than the fee for an office visit, home services are still less than the medical care the patient would receive in the emergency department.