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Ophthalmology and Optometry Coding Alert

E/M Services:

Answer 'Separate' or 'Inherent' Question Before You Use Modifier 25

Published on Fri Aug 20, 2010

Not all preprocedure services constitute a separate E/M. When an ophthalmologist performs an E/M service and a procedure on the same patient during the same encounter, you may be able to report the E/M using modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). Or you may not. In order to rightfully code an E/M-25, you must prove that the E/M is a separate service and is not an inherent component of the procedure. Follow this advice to find out when to report an E/M with modifier 25, and when to leave the E/M off the claim. Include Evidence of Separate E/M in Notes The basics: Coders should use modifier 25 when a significant, separately identifiable E/M service is performed by the same physician at the same face-to-face encounter as a procedure or other service. The most vital [...]
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