Ophthalmology and Optometry Coding Alert

Question: We use codes 99251-99255 for initial hospital consults. But what should we use for follow-up hospital visits after our ophthalmologist has done the initial consult? I'm just not getting the difference between 99231-99233 and 99261-99263. Any help would be much appreciated.


New Mexico Subscriber


Answer: Depending on the situation, you may report either a follow-up inpatient consultation code (99261-99263, Follow-up inpatient consultation for an established patient ...) or a subsequent hospital care code (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...).

Use 99261-99263 when:

1. the attending physician requests a subsequent consultative visit from the ophthalmologist, and

2. the ophthalmologist performs the follow-up visit to complete the initial consultation. On the other hand, if the ophthalmologist assumes patient care, you should assign 99231-99233. Therefore, if the ophthalmologist initiated treatment at the initial consultation and thereafter participated in the patient's management, you should report a code for subsequent hospital care, not a code for follow-up inpatient consultation.

Documentation tip: Unlike an outpatient consultation (99241-99245, Office consultation for a new or established patient ...), codes 99261-99263 do not require that the ophthalmologist send a written report to the attending physician. The attending physician should record the request, review and report in the patient's shared medical chart. Advice for You Be the Coder and Reader Questions provided by Maggie M. Mac, CMM, CPC, CMSCS, consulting manager for Pershing, Yoakley & Associates, Clearwater, Fla; and Raequell Duran, president of Practice Solutions, Santa Barbara, Calif.