Ophthalmology and Optometry Coding Alert

Question: We have a pediatric ophthalmologist who has started to see patients for second opinions after another ophthalmologist has seen them. Is there a particular office visit code we should be using for these services?

Ohio Subscriber

Answer: Use the confirmatory consultation codes, 99271-99275 (Confirmatory consultation for a new or established patient ...). CPT instructs you to use these codes "to report the evaluation and management services provided to patients when the consulting physician is aware of the confirmatory nature of the opinion sought (e.g., when a second/third opinion is requested ...)."
 
CPT further advises that the confirmatory consult should consist of "an opinion and/or advice only." Code any services the pediatric ophthalmologist provides beyond providing an opinion or advice at the appropriate level of office visit.
 
CPT has not yet established typical times for this group of procedure codes. Therefore, you will not be able to use time as a factor in determining the level of code to report.