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Ophthalmology and Optometry Coding Alert

Reader Questions:

Eye Exam vs. Consultation Coding

Published on Mon Feb 23, 2009

Question: We had a 55-year-old patient with type 1 diabetes come in presenting with a chief complaint of blurred vision (both distance and near). The patient's primary care physician told her she needed an eye exam. Other than the diabetes, she's in good health, but my ophthalmologist diagnosed mild non-proliferative diabetic retinopathy and mild diabetic macular edema. He ordered fundus photographs and an extended threshold fields exam. How should I report all these services? Should I start with a consultation code? New York Subscriber Answer: You may only report a consultation code if the primary care physician has specifically requested your ophthalmologist's opinion, advice and recommendations for treatment. This does not seem to be true in the scenario you relate in your question. Your ophthalmologist may report an E/M code (99201-99215) depending on the service level he provided and documented or one of the ophthalmology service codes (92002-92014), again based [...]
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