Ophthalmology and Optometry Coding Alert

Question: We commonly see patients referred by another physician. Our ophthalmologist performs an office exam that frequently results in a later procedure. Should we code these as consultations or transfer of care? Do we need a written notice from the referring physician for consultations?Texas SubscriberAnswer: Consultations are requests from an appropriate provider for advice, opinion, or recommendations on treatment. This can be for a known or unknown problem. Therefore, if a provider is sending patients to your ophthalmologist for the same problem on a regular basis, the request can be interpreted as a transfer of care for your physician to manage the problem. This is not a consult and should be billed with the 99201-99215 (new or established) office visit code (99201-99215, Office or other outpatient visit ...) as appropriate.On the other hand, if an appropriate provider sends the patient to your ophthalmologist with the intent of receiving a recommendation [...]