Ophthalmology and Optometry Coding Alert

Question: An emergency department physician asked our ophthalmic surgeon to see a patient with severe eye trauma. The ED doctor specifically requested that our ophthalmic surgeon take responsibility for treating the patient, so I don't think this can count as a consult. I'm not sure, however, if I can report an ED visit for our ophthalmic surgeon, who is not an ED physician. How should I report the visit?

New York Subscriber

Answer: A common misconception is that only ED physicians can report ED services (99281-99285, Emergency department visit for the E/M of a patient). In fact, any physician can report the ED codes if he provides a service in the ED. This does not mean, however, that an ED code is the only choice when a physician sees a patient in the ED.
 
According to the Medicare Carriers Manual section 15507, specialists should report an ED visit for services rendered in the ED, unless:
 
• The service provided meets the criteria for a consult
 
• The physician delivers critical care services (99291-99292) upon arriving at the ED, or
 
• The physician admits the patient to the hospital (99221-99223, Initial hospital care, for the E/M of a patient ...; 99218-99220, Initial observation care, per day, for the E/M of a patient ...; 99234-99236, Observation or inpatient hospital care, for the E/M of a patient including admission and discharge on the same date ...).

As you describe your case, and because the ED physician transfers care to the surgeon, you should report an ED visit, such as 99282. But if the ED physician had already seen and evaluated the patient prior to determining a need to transfer care to the specialist, it would not be appropriate for the ophthalmologist to report an ED visit. In this case, the ED physician will report the ED code, and the specialist will report his services for a hospital admission, observation care or outpatient visit.