Ophthalmology and Optometry Coding Alert

Question: We have a doctor who likes to charge an evaluation and management (E/M) code with a starred procedure (i.e., foreign body removal.) There is no differentiating diagnosis; however, starred procedures are for surgical procedures only. Any suggestions?

Arkansas Subscriber

Answer: You can bill an E/M with a starred procedure, but it must be documented properly and billed properly. For example, a patient is scheduled to come in to have a foreign body removed from his eye. You would only code the removal of foreign body (65205*, 65210*, 65220* or 65222*), because this was a scheduled service.

As another example, if the patient were coming in because the eye was swollen and red and the ophthalmologist examined it and found a splinter, then you would code removal of foreign body with the E/M services code and a modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service). Modifier -25 states a separate E/M was done on the same day as a procedure, but there does not have to be a different diagnosis. Further, starred procedures always allow the billing of an E/M service. Also, if the patient comes in for a procedure and the doctor addresses a different problem, the same rule applies: you can bill the procedure and the E/M with a modifier -25. A high volume of -25 modifier visits could send up some red flags with a payer. But if it is appropriate and documented correctly, you can bill it. In the documentation, ask the physicians to make a separate entry for the visit from the minor procedure performed.