Ophthalmology and Optometry Coding Alert

'Second opinions' become just another E/M service

You may have fewer choices to make when reporting consult codes in the new year: CPT 2006 has plans to eliminate follow-up inpatient (99261-99263) and confirmatory (99271-99275) consultations. All Follow-Ups Become Subsequent Care Beginning Jan. 1, 2006, you may be reporting all facility visits, except the first, during the same inpatient stay using subsequent care codes 99231-99233 (hospital) or 99311-99313 (nursing facility).

Under current guidelines, the surgeon may report a follow-up inpatient consultation for subsequent visits during a single inpatient stay, as long as the visit meets the criteria of request with reason, opinion rendered, and report, says Suzan Hvizdash, BSJ, CPC, physician education specialist for the department of surgery at UPMC Presbyterian-Shadyside in Pittsburgh. The elimination of 99261-99263 for 2006 means that come January, you may no longer have that option--even if the service meets the requirements of a consult and the surgeon does not assume responsibility for any portion of the patient's care. Don't Overlook Initial Consult If these changes take effect, you will still need to report an initial inpatient consult (99251-99255) for the surgeon's first visit with the patient per inpatient stay, as long as the service meets all the requirements of a consult, says Susan Callaway, CPC, CCS-P, an independent coding auditor and trainer in North Augusta, S.C.

Example: On Jan. 2, 2006, a managing physician requests that your ophthalmologist provide a consultation for a hospital inpatient complaining of floaters and flashing lights. The ophthalmologist documents the request, examines the patient and shares his findings with the managing physician.

In this case, you would report an initial inpatient consult (for example, 99254, Initial inpatient consultation for a new or established patient ...), as well as any diagnostic tests the ophthalmologist provides (for example, 92225, Ophthalmoscopy, extended, with retinal drawing [e.g., for retinal detachment, melanoma], with interpretation and report; initial).

The next day, Jan. 3, 2006, the managing physician once again asks the ophthalmologist to examine the patient because of new symptoms. Again, the ophthalmologist documents the managing physician's request, examines the patient and shares his findings.
 
For the follow-up visit, assign subsequent hospital care codes (for instance, 99232, Subsequent hospital care, per day, for the evaluation and management of a patient ...).

This visit looks like a consult, but you will need to report subsequent care if CPT 2006 makes 99261-99263 invalid. Celebrate the Change Some good news: Deletion of 99261-99263 would ease documentation requirements for physicians and headaches for coders trying to choose between follow-up consults and subsequent hospital care, Hvizdash says. You would be able to simply choose 99231-99233 for hospital inpatients or 99311-99313 for nursing facility patients.

And some great news: As a bonus, subsequent hospital care codes generally reimburse better than [...]