Optometry Coding & Billing Alert

Question: Can an optometrist bill for a written report to the physician who originally referred the patient to us? If so, what special codes or additional information do we need to provide?

South Carolina Subscriber

Answer: First, determine if this patient was a true referral or if this is a consultation. The documentation from the referring physician should help you decide, but if not, determine what the referring physician expects of you. If you are to treat the patient, then that is a true referral, and no further communication with the referring physician is necessary.
 
But if you are to render an opinion and then send the patient back to the referring doctor for treatment, the visit is a consultation, and you should send a referral letter to explain your findings. AMA guidelines require that "the consultant's opinion and any services that were ordered or performed must be documented in the patient's medical record and communicated by written report to the requesting physician or other appropriate source."
 
The cost of the time involved in preparing the written report is included in the payment for the consultation codes (99241-99245). Remember, all three elements (history, exam and decision-making) must be met for these codes, unlike the requirements for the eye codes (92002, 92012, 92004, 92014).
 
Good idea: Send a referral letter or thank-you note in either case - this will help build strong working relationships with referring physicians.