special Ophthalmology codes and modifier 25

cmmfeyen

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I'm new to Ophthalmology and the company I'm working for doesn't have any credentialed coders on staff - I'm the first one. I'm questioning the use of modifier 25 on the ophthalmology codes 92002-92004 & 92012 - 92014. If the provider does a comp exam and a foreign body removal, should we be using a -25 on the 92014? Are these special ophthalmology codes procedures codes or are they E/M codes? Thank you for any help given!!!
 

Cheezum51

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First, the 25 modifier should be used with the 99 E/M codes. As to whether they're being used appropriately, kind of depends on what's written in the chief complaint. If the CC is something like, "PT notes FB sensation in OD x 3 days. Flushed with water did not help", then the office visit gets bundled in with the FB removal code and you only bill the 65222 and no E/M code.
However, if the patient came in for another reason, say their annual diabetic medical eye exam, and the doctor also found a FB and removed it, then you could bill the E/M with the ICD-10 code for the diabetes, add the 25 modifier to that and then bill the FB removal code with the appropriate FB ICD-10 code.
If the add the FB ICD-10 code as another code for the E?M, they'll most likely deny payment and just pay you for the FB removal and not the 99 code.

Tom Cheezum, OD, CPC, COPC
 

cmmfeyen

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First, the 25 modifier should be used with the 99 E/M codes. As to whether they're being used appropriately, kind of depends on what's written in the chief complaint. If the CC is something like, "PT notes FB sensation in OD x 3 days. Flushed with water did not help", then the office visit gets bundled in with the FB removal code and you only bill the 65222 and no E/M code.
However, if the patient came in for another reason, say their annual diabetic medical eye exam, and the doctor also found a FB and removed it, then you could bill the E/M with the ICD-10 code for the diabetes, add the 25 modifier to that and then bill the FB removal code with the appropriate FB ICD-10 code.
If the add the FB ICD-10 code as another code for the E?M, they'll most likely deny payment and just pay you for the FB removal and not the 99 code.

Tom Cheezum, OD, CPC, COPC
Tom - Thank you for your response. What I'm really wondering is if we should be using modifier 25 on the ophthalmology codes (92002, 92004, 92012, 92014)?? They have been using them and the payers are paying on them, so far.
 

saddie2k

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Yes, the 25 can be added to the eye codes. They are office visit codes, not procedure codes.
 
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