Optometry Coding & Billing Alert

Question: We have a joint practice with an optometrist and an ophthalmologist. Can the OD see a patient and charge an eye code (92004-92014) and then ask the MD to see the patient on the same day for a consultation, with the MD charging a consultation code?


South Dakota Subscriber


Answer: Yes, according to the Medicare Carriers Manual. Chapter 15, item 15506 directs carriers to pay "if one physician in a group practice requests a consultation from another physician in the same group practice as long as all of the requirements for use of the CPT consultation codes are met." Those requirements are:

1. The consultation must be provided by a physician whose opinion or advice regarding evaluation and management of a specific problem is requested by another physician or other appropriate source (unless it is a patient-generated confirmatory consultation).

2. A request for a consultation from an appropriate source and the need for consultation must be documented in the patient's medical record.

3. After the consultation is provided, the consultant prepares a written report of his findings, which is provided to the referring physician.

Documentation: In an intra-office setting, where the optometrist and ophthalmologist can both see the patient's record, the manual states that "the documentation requirement may be met by a specific written request for the consultation from the requesting physician or if the consultant's records show a specific reference to the request. In this setting, the consultation report is a separate document communicated to the requesting physician."