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Ophthalmology and Optometry Coding Alert

You Be the Coder:

Glaucoma Follow-Up for Nursing Home Patient

Published on Tue Jan 18, 2005

Question: How should I code an office visit for a wheelchair-bound nursing home patient who comes in for a follow-up for glaucoma?


Texas Subscriber


Answer: Ophthalmologists often have to follow up with glaucoma patients because of medications or postsurgical concerns. Many practices differ in their coding method for follow-up visits, using either E/M or eye codes. Both sets are acceptable as long as they accurately depict the service. The decision usually depends on the physician's preference. Some practices choose the eye codes because they require less documentation. However, the ophthalmologist must perform the required exam elements, and he must consider those elements medically necessary for the patient's presenting problem, to bill the appropriate eye code level.

In documenting follow-up glaucoma visits, be sure always to document a chief complaint even if it is simply "follow-up glaucoma."

Hidden trap: Billing can be complicated if the nursing home resident is a skilled nursing facility (SNF) patient. In that case, the nursing home is receiving a monthly payment from the Medicare program and is responsible for the payment for all the services the patient requires. Lately, many providers have been receiving letters from their Medicare carriers asking for refunds and instructing them to seek payment from the SNF. The SNF, however, may deny payment, claiming they did not know your ophthalmologist was going to see their patient.

Disaster averted: Calling the nursing home before the ophthalmologist sees the patient to make sure the patient is not at SNF level - and that you can bill Medicare - will save you time and money in the future.

Note that even though the patient is from a nursing home, the place of service is always where she is seen - in this case, your office.

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