Ophthalmology and Optometry Coding Alert

Question: A new patient presented with a suspected ophthalmic lesion, and the nurse took the patient back to the room and took her vitals. But when the physician came into the room, the patient said she couldn’t stay any longer and she left without anyone completing the visit. Can we bill anything for this visit?

Codify Subscriber

Answer: Unfortunately, you cannot. Just because the nurse saw the patient doesn’t mean you can file a claim; if the physician did not have a face-to-face encounter with the patient, you cannot bill for this scenario.

If the nurse had provided a service to an established patient beyond taking vitals under a previously defined plan of care to be provided by the nurse, you may have been able to report 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). However, you note that you saw a new patient, and 99211 is therefore not applicable even if the nurse had provided a more extensive service beyond vitals. Keep in mind that the E/M code 99211 provided by ancillary staff still requires that a physician has seen the patient and documented a follow-up plan of care in order to bill the 99211 code.