Ophthalmology and Optometry Coding Alert

Question: We have one ophthalmologist who visits patients in nursing homes and evaluates them for eye pressure, cataracts, and any other conditions that they might have. What criteria should I use to differentiate between the nursing facility place of service (POS) codes?

Alabama Subscriber

Answer: Confusion about the three nursing home POS codes often arises because a facility can have both skilled nursing and non-skilled nursing beds at the same time. Check out the following three nursing home classifications to determine whether these might apply to your doctor’s visits:

POS code 31 (Skilled nursing facility): Use this code when your eye care physician 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 eye care physician 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 to treat complications following a recent cataract excision, the ophthalmologist would be able to see the patient at the custodial care facility.