Ophthalmology and Optometry Coding Alert

Question: When my ophthalmologist does a comprehensive exam (92004) and decides to insert punctal plugs on the same day, do I need the 25 modifier on the exam?Texas SubscriberAnswer: If you plan to report 92004 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient ...) separately, then yes, you would need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).You should first check that your chart note supports billing the E/M with modifier 25. You have to prove that the E/M was a significant, separate service from the punctal plug insertion (68761, Closure of the lacrimal punctum; by plug, each) because every procedure has a small amount of E/M service already built into it.Tip: Ask yourself whether the E/M documentation -- which should also indicate medical necessity for [...]