Ophthalmology and Optometry Coding Alert

Question: If my ophthalmologist performs an office consultation on a patient, how much time must elapse before we can bill 99241-99245 again for the same patient?

Florida Subscriber
 
Answer: CPT and Medicare don't restrict how often you can report an office consultation for the same patient. You should bill 99241-99245 (Office consultation for a new or established patient, which requires these three key components ...) if the visit meets a consultation's three criteria. An appropriate source, such as another physician, must request your ophthalmologist's opinion regarding the patient's condition. Your ophthalmologist must render the examination and then report his findings to the requester in writing.
 
Example: A family practitioner requests your ophthalmologist's opinion on a 16-year-old female with blurred vision. Your ophthalmologist evaluates the patient and issues a report to the family physician. You code the visit with 99244 (... for a new or established patient).
 
Six months later, the same (or another) physician requests a consultation for a re-evaluation of the same (or a different) problem. You may report a consultation for this visit as well, even though the consultations occur within the same six months.
 
Don't miss: The key in reporting a consultation is the request for an opinion or advice from another appropriate provider. Of course, documentation in the medical record must support all the other requirements in reporting consultation services.
 
If an insurer denies or downcodes the consultations for frequency, contact the Florida Department of Insurance and report the payer's activities. Florida imposes fines on payers that downcode 99241-99245 to 99212-99215 (Office or other outpatient visit ...).