Resolved OD referring to an MD for cataract eval

[WendyS_92520]

An OD is billing moderate complexity when he determines the patient is ready for a cataract evaluation. Stating he is assuming risk when referring for the cat eval along with the MD. Is moderate complexity really met?

 

[NadineE_92105]

Simply referring for a cataract evaluation and stating shared risk with the MD usually doesn't meet moderate complexity E/M criteria for an OD visit. Moderate complexity requires managing more complex problems, reviewing significant data, or higher risk management during that visit. Referral alone is generally lower complexity. This scenario would typically fall under a lower level of E/M service based on the straightforward or low complexity of the medical decision-making during that specific visit.