Ophthalmology and Optometry Coding Alert

Question: Our ophthalmologists sometimes go to see patients in nursing homes. What criteria should I use to differentiate between the nursing facility POS codes?

Alabama Subscriber

Answer: Confusion about the three nursing home POS codes arises because a facility can have both skilled nursing and nonskilled nursing beds at the same time.
 
POS code 31 (Skilled nursing facility): Use this code when your ophthalmologist treats a patient who is in a skilled bed at the time of service. This means the patient has a medical condition that requires skilled nursing care, such as injections or ventilation. Medicare must authorize skilled nursing services and considers them a Medicare Part A expense.
 
POS code 32 (Nursing facility): Choose code 32 if the patient is not on Part A Medicare, but instead is on long-term care and receiving medical, nursing or rehabilitative services.
 
POS code 33 (Custodial care facility): These facilities provide patients with long-term personal assistance services, but do not provide medical care (although they do provide assistance, such as dispensing medications). Patients are mobile in a custodial care facility, so there must be medical necessity for an ophthalmologist to see a patient at the facility and not in his office.
 
Example: If a patient in the custodial facility fractures a hip and is unable to go to the ophthalmologist's office, the ophthalmologist would be able to see the patient at the custodial care facility.
 
A patient is allowed only a certain number of SNF days per year. If a nursing facility brings a patient to the physician's office, you should report POS code 11 (Office) on the claim form.