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Thread: Hospital Based Ophthalmology coding

  1. #1
    Join Date
    Apr 2007
    Minot ND

    Question Hospital Based Ophthalmology coding

    AAPC: Back to School
    any thoughts?
    We're a out pt hospital based ophthalmology/optometry clinic and as such I code both the professional and facility charges. For the E&M codes I use a the nursing activities to code for the facility charge and it's often not the same level as the professional side, but for the Eye codes I've only used the same eye code for the facility side. Should I be using the E&M levels for the facility side even though the professional charge is an eye code??

    Anyone else hospital based Ophthalmology/Optometry clinic? Anyone else have problems with hospital coders not understanding or wanting to deal with the ophthalmology coding?

  2. #2

    Smile MRIT, Consult

    Hi Valerie,

    I am back in town so call me on Monday and we will discuss your question. I think I can give you the guidance you need.


  3. #3
    Join Date
    Apr 2007
    Columbia, MO


    The facility should have an assement criteria for all patients that are seen in the clinics or ER. This is not the same as the physician criteria. The facility is assessing the utilization of the resources, so if there are resources used that are not a part of the other procedures you are coding then yess there should be a facility E&M even though there is not one on the physician side.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4


    I am a outpatient based ophthalmology practice and we also have hospital based optometrists.

    The ophthalmologists use E/M or Eye Codes, as do the optoms.

    The hospital has a matrix which defines what is included under their E/M levels for facility charges. So, there is a baseline 99201/99211 which has all these functions listed ...transporting patient, putting patient in exam room, preparing chart, etc. The next level 2 would be the level 1 functions plus additional functions, level 3 is what's in level 2 + additional, and so on.

    The hospitals get to make up their own grids and two hospitals don't have to match and the hospital's facility coding does not have to match the physician's at all.

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