Ophthalmology and Optometry Coding Alert

Correctly determining when modifier -25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) is a justified appendage to an office visit - E/M codes, eye codes and consultations - can be the difference between a denied and a paid minor procedure claim. Suppose a patient comes in for a glaucoma check and that's her main complaint. But during the check she also complains that she has an irritation on the other eye. It could be that she has trichiasis, which means she needs lash epilation. In this case, both the glaucoma E/M service and the epilation minor procedure would have to be coded, says Marcia Porter, CPC, CHCC, an ophthalmology coder in Charleston, SC. "We need -25 for the E/M code, which corresponds to the glaucoma diagnosis" to be paid for both services when performed on the same day during the same visit. Another case that requires -25 is if a patient presents with localized swelling and erythema underneath her left eye that has no discharge but has lasted for one week, which the physician initially diagnoses as 379.92 (Unspecified disorder of eye and adnexa; swelling or mass of eye). After the ophthalmologist performs a complete E/M on the patient and diagnoses the inflammation as a chalazion, he performs an incision and drainage/curettage of the chalazion. If the coder recognizes the office visit and initial diagnosis as separately identifiable, the services rendered the patient will be billed an E/M code (99201-99215) or an eye code (92002-92014) with modifier -25 and the minor procedure code (67800-67805). Link the E/M service to the initial diagnosis of 379.92 and the chalazion procedure code to the post-E/M service diagnosis, 373.2 (Inflammation of eyelids; chalazion). If the coder had not appended modifier -25 to the office visit, it would have been considered a preoperative visit and not payable under the chalazion removal's global surgical package. Coders should append modifier -25 to E/M or eye codes to indicate that the visit was separate from that required for the procedure and that a clearly documented, distinct and significantly identifiable service was rendered, according a recent AAPC conference presentation from Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, consultant and CPC trainer for A+ Medical Management and Education in Absecon, N.J.

When submitting the paper claim, you should not need any additional documentation other than what is usually required for both the minor procedure and the office visit, says Beverly Cilas, CPC, coding specialist with Ford Caserta Eye Center in Tempe, Ariz. Use One ICD-9 Code Comfortably Some coders state that you must have separate diagnosis codes for the office visit and the minor procedure in [...]