Optometry Coding & Billing Alert

Published on Tue Oct 03, 2006 PDF

Question: Our optometrist saw a patient for a brief visit in her home. I coded 99321 (Domiciliary or rest home visit for the evaluation and management of a new patient ...) and was denied for using an invalid procedure code. What's wrong?

Arkansas Subscriber

Answer: If the optometrist saw a patient in a private residence (place-of-service code 12, Home; Location, other than a hospital or other facility, where the patient receives care in a private residence), report an E/M code from the -Home Services- series.  

For new patients, report 99341-99345 (Home visit for the evaluation and management of a new patient ...).

For established patients, report 99347-99350 (Home visit for the evaluation and management of an established patient ...).

The code you reported, 99321, was likely denied for two reasons:

- Codes 99321-99323 and 99331-99333 (... established patient ...) were deleted in 2006. The new codes, 99324-99328 for new patients and 99334-99337 for established patients, provide more levels of service to choose from.

- Even if you had reported a current code, it would not have been correct for the POS. Codes 99324-99337 describe care given in a -domiciliary, rest home or custodial care- facility (POS 33) -- not care provided in a private residence.