Medical Billing Forum

Coding => Coding => Topic started by: eyetech48326 on January 15, 2009, 09:12:03 PM

Title: ophthalmology coding
Post by: eyetech48326 on January 15, 2009, 09:12:03 PM
Hi. I am thrilled to be @ home and be able to have a site to answer billing questions. :)
I'm an ophthalmic tech and part of my responsibilities are to code dx and procedures on our billing sheets. Ophthalmology codes are different in that we not only have the "e &m" codes, but also have codes specific to ophth. I've been at my current practice almost 1 year. Today I was told that we cannot bill a consult on an established patient. That doesn't make sense to me. I'll explain the scenario: We have a pt that we have been seeing yearly for 3 yrs because they are diabetic. A new doctor has referred (in writing) this same pt. for a new problem, not connected to diabetes. I was told that we can't bill a consult code(sorry, I don't have the proc code of which I am speaking at my fingertips right now) I don't see why not. This is a new doctor asking us to see the pt for a new problem. As long as my doctor writes a letter, and the work up of the pt meets the requirements of a "Consult", why not bill the office visit as a consult?
If I need to give you the actual procedure code #'s I can bring them home with me after work tomorrow. Thanks!
Just to let you know, I'm dicussing this with the biller that has been with this particular doctor for 8 yrs. She may not want to hear that the "newbie" knows more than she does about this subject! Or maybe I am in the wrong?
Title: Re: ophthalmology coding
Post by: Michele on January 16, 2009, 11:18:39 AM
   Although it is not a common situation, it does come up where a doctor needs to do a consult on an existing patient.  In the CPT book, put out by the AMA, under the consultation codes it indicates that the office consultations (99241 - 99245) are for "New of Established Patient".  So consultations can be performed and billed for established patients.

Hope that helps.