Ophthalmology and Optometry Coding Alert

You'll follow 2 sets of rules unless insurers kiss 99241-99255 goodbye. When your ophthalmologist evaluates a patient at the request of an optometrist, and the patient returns to the optometrist for further care, do you code the encounter as a consultation? In 2010, the answer could be "yes and no." Although the AMA clarifies the transfer of care definition in the CPT book, Medicare did not feel another clarification was the answer to an ongoing problem with consultation coding. The decision to eliminate payment for consultation codes provided to Medicare patients was made after the AMA published the 2010 CPT books. Whether private payers will follow suit is now a question and concern for health care providers. Continued Errors Result in E/M Boom The Office of Inspector General found a high error rate on appropriate use of consultation codes. Different opinions on when a transfer of care occurs versus a [...]