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Ophthalmology and Optometry Coding Alert

Reader Question:

E/M With 68761? Check Documentation First

Published on Tue Jun 07, 2011

Question: When the ophthalmologist does a comprehensive exam (92004) and decides to insert punctal plugs on the same day, do I need to append modifier 25 to 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, 1 or more visits) 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). Some payers may pay for the "eye codes" without modifier 25 when reported with a procedure or diagnostic service.You should first check that your chart note supports billing the eye code with modifier 25. You have to prove that the eye code was a significant, separate service from the punctal plug insertion (68761, Closure of the lacrimal punctum; by plug, each) because every procedure has [...]
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