Ophthalmology and Optometry Coding Alert

Question: A patient originally came to our office based on a referral for a procedure. The ophthalmologist subsequently sees the patient for a problem that the procedure manifested. May I report a consult for the subsequent visit?


Maryland Subscriber
Answer: You should code this service as an established patient office visit (99212-99215, Office or other outpatient visit for the evaluation and management of an established patient ...) or as subsequent hospital care (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...), depending on the setting.

Because the subsequent visit is for managing the patient's condition, you should not consider it a consult. If the patient is in a global, postoperative period from the procedure performed, the visit would be postoperative and not billable.

Exception: If the referring physician requests the subsequent consult visit, the encounter may qualify as a consultation (99241-99255). The patient's medical record should contain documentation of the request for opinion, rendering of findings, and report to the requesting physician.