Optometry Coding & Billing Alert

Question: A local gastrointestinal doctor asked me to check one of his patients for the presence of a Kayser-Fleischer ring. The time involved was minimal, there was no need for me to treat the patient, and I am going to write him a letter listing my observations. Should I report a consultation code or a confirmatory code?


Texas Subscriber


Answer: Report an outpatient consult code (99241-99245, Office consultation for a new or established patient ...), not a confirmatory consultation code (99271-99275, Confirmatory consultation for a new or established patient ...).
 
According to the CPT instructions for consultations, a "confirmatory" consult is one initiated by a patient or family, and not requested by a physician. A confirmatory consult can also be requested by a third-party payer. Therefore, requests coming from another physician would be an outpatient (or inpatient) consult (if the requesting physician is only requesting an opinion) or a referral (if the patient has already been diagnosed and the requesting physician is asking you to treat the patient).

Alternative: Depending on how many items of an exam you document and whether you write the referring doctor a letter, consider reporting 92002 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient) or 92012 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient) for the visit.

Depending on the carrier, 92002 or 92012 might pay better than a lower-level consult code and they don't require a written response to the referring doctor. Obviously, it will still be appropriate to contact the referring doctor, but a telephone call might be equally appropriate, depending on your relationship with that doctor.

Bottom line: You do not necessarily have to report a consultation code for a consult visit - it's your decision.

Advice for Reader Questions and You Be the Expert contributed by David Gibson, OD, FAAO, practicing optometrist in Lubbock, Texas; and Charles Wimbish, OD, president of Wimbish Consulting Group in Martinsville, Va.