Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologist saw a patient for a brief visit in her home. I coded 99321 (Domiciliary or rest home visit for the evaluation and management of a new patient ...) and was denied for using an invalid procedure code. What's wrong?

Pennsylvania Subscriber

Answer: If the ophthalmologist saw a patient in a private residence (place-of- service code 12, Location, other than a hospital or other facility, where the patient receives care in a private residence), report an E/M code from the "Home Services" series. For new patients, report 99341-99345 (Home visit for the evaluation and management of a new patient ...). For established patients, report 99347-99350 (Home visit for the evaluation and management of an established patient ...)
 
The code you reported, 99321, was likely denied for two reasons:
 
• Codes 99321-99323 and 99331-99333 (... established patient ...) were deleted in 2006. The new codes, 99324-99328 for new patients and 99334-99337 for established patients, provide more levels of service to choose from.
 
• Even if you had reported a current code, it would not have been correct for the POS. CPT codes 99324-99337 describe care given in a "domiciliary, rest home or custodial care" facility (POS 33) -- not a private residence.

 -- 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, CPC, president of Practice Solutions, Santa Barbara, Calif.