Ophthalmology and Optometry Coding Alert

Question: We saw a patient who was considered an inpatient and was brought to the office by wheelchair van. Should I code this as an office/outpatient consult or an inpatient consult? I thought we had to code according to the status of the patient instead of the place where the consult was done.

Idaho Subscriber

Answer: You're right. The status of the patient does determine whether the ophthalmologist is performing an inpatient or outpatient consult. Since your patient was a hospital inpatient, report an initial inpatient consultation code (99251-99255), regardless of where the ophthalmologist saw him.

The introduction to the 99251-99255 code series in the CPT book confirms that those codes "are used to report physician consultations provided to hospital inpatients, residents of nursing facilities, or patients in a partial hospital setting."

Hidden trap: Since you're reporting an inpatient consult code, the place of service (POS) listed on your claim form has to match. Use the name of the hospital the patient came from for the POS. However, in box 32 of the CMS claim form - or the equivalent area on an electronic claim - leave your office address.

- Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.