Ophthalmology and Optometry Coding Alert

Question: Six months ago, the ophthalmologist did a consult in the hospital and has not seen the patient since. The patient's primary-care physician called and, again, wants to consult with the ophthalmologist. Can we code for an office consult (99244), even though she also did a hospital consult for the same patient six months ago?

Louisiana Subscriber Answer: Yes, you can code a consult anytime there is a new request for an opinion or advice, if the documentation supports the request and your written opinion is provided to the requesting physician following that service. Medicare specifies no time limit for consultations. However, some commercial carriers will limit consults to only one consult per year per specialty.
 
In this case, if another ophthalmologist has seen the patient in consultation earlier in the year, the second ophthalmologist should code a new patient visit rather than a consultation when she sees the patient later that same year - even if her visit meets the criteria for a consultation.