Ophthalmology and Optometry Coding Alert

Question: I just started working in an ophthalmologist's office and I have a question about modifiers. Can we append modifiers -25 or -57 to the eye codes 92002-92014? The descriptions of the modifiers only specify E/M codes - do the eye codes count?


Arizona Subscriber


Answer: Medicare and most other carriers treat the eye codes - 92002 (Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient), 92004 (... comprehensive, new patient, one or more visits), 92012 (Ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient) and 92014 (... comprehensive, established patient, one or more visits) - the same as E/M codes.
 
Therefore, if there is a separately identifiable E/M service, you can report it with an eye code and append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) or -57 (Decision for surgery).

Chapter 11 of the National Correct Coding Policy Manual for Part B Medicare Carriers makes the comparison official: "When evaluation and management codes are reported, these general ophthalmological service codes ... are not to be reported; the same services would be represented by both series of codes." Meaning you can report either an E/M code or an eye code.