Ophthalmology and Optometry Coding Alert

Question: Thank you for your article last month about consult coding. One of our main payers still reimburses for these visits and we see them from time to time. Here’s the problem – one of our physicians writes “consult” on every new patient chart. This is confusing for our billing service, which is an outside vendor. Is there a way to ease this confusion?

Codify Subscriber

Answer: The solution is likely to be two-fold. First, speak to your ophthalmologist and make sure he knows that the term “consult” has a specific code range assigned to it, and thus using that word for every visit might lead to confusion. Educate the physician about what a true consult constitutes (requested opinion, rendered service, and report back to the requesting physician) versus what a standard office visit means.

In addition, you should speak with your billing vendor to ensure that their staff members know how to glean CPT^® codes from your physicians’ notes. Make sure they know the difference between a consult and an office visit so they can determine a code based on the documentation and aren’t simply relying on the physician’s note marked “Consult” on the top of a chart to select their codes.

Chances are that the word “consult” will continue to appear in medical charts, despite whether or not your practitioners are performing true consultations, so ensuring that everyone involved in the coding process knows how to choose between office visit and consult codes is essential.