Ophthalmology and Optometry Coding Alert

Question: When an ophthalmologist who is a non-hospice provider performs a medical visit at a hospice patient's home, how should I code the service? Medicare is denying these services as noncovered. Georgia Subscriber Answer: You should report home services (99341-99350) with the appropriate HCPCS modifier. For a home visit to a new patient, assign 99341-99345 (Home visit for the evaluation and management of a new patient ...). When the ophthalmologist treats an established patient at home, use 99347-99350 (Home visit for the evaluation and management of an established patient ...). Append the home service code with modifier GV or GW based on: the condition the ophthalmologist evaluates and manages and whether the physician is a hospice provider. If the ophthalmologist provides services related to the hospice patient's terminal condition, you should use modifier GV (Attending physician not employed or paid under arrangement by the patient's hospice provider). Caution: Reserve modifier [...]