Ophthalmology and Optometry Coding Alert

Question: We are having some trouble getting paid on office visits within the postoperative period. At times our doctors bill an eye code (920xx) or an evaluation and management (E/M) code (992xx) and we append a -24 modifier, yet we will get denied. Is the -24 modifier exclusively for E/M services or can we use it on eye codes as well? And does the diagnosis code need to be different from the diagnosis used in surgery?

Colorado Subscriber

Answer: According to CPT, the -24 modifier (unrelated E/M service by the same physician during a postoperative period) instructional notes indicate The physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. This circumstance may be reported by adding the modifier -24 to the appropriate level of E/M service. Therefore, the -24 modifier would not be used on eye codes 92002 through 92014. The diagnosis for performing the E/M service and eye exam on the eye that had the surgery during the postoperative period should be different than the diagnosis used for the surgery. This indicates the medical necessity for performing and charging for the service within the postoperative period. The appropriate HCPCS codes -RT for right and -LT for left should be appended to the CPT code to indicate right eye and left eye.