AAPC - Back to school
Results 1 to 4 of 4

Thread: Ophthamological exam under anesthesia - 25 or 59 modifier

  1. #1
    Join Date
    Apr 2007
    Iowa City, IA

    Question Ophthamological exam under anesthesia - 25 or 59 modifier

    AAPC: Back to School
    There is a new NCCI edit that became effective 7/1/2009 in which the 92018 is considered part of the major procedure 67210 (and many others). The edit states that a modifier is allowed to unbundle the code pair.
    My question is whether the 25 or 59 modifier is most appropriate to append to the 92018

  2. #2
    Join Date
    Apr 2007
    Adirondack Chapter of Professional Coders, Glens Falls, NY


    I would say not 25 as this modifier is used for E/M services only. 59 would work, but the procedures would have to be ones that are not normally reported together but are appropriate under the circumstances. I would maybe try modified 51 for multiple procedures.

  3. #3
    Join Date
    Apr 2007
    Iowa City, IA

    Default Ophthamological exam under anesthesia - 25 or 59 modifier

    92002, 92004, 92012, 92014 are specialized eye exams that are considered as E&M codes by most payors and a -25 modifier is appended to them. 92018 is also a specialized eye exam except it is done under anesthesia. Why wouldn't it use a -25 modifier as well?

  4. #4
    Join Date
    Apr 2007
    Murrieta, CA


    The reason you would not use the -25 modifier is because the exam is (or shouldn't be) performed in the office setting. It should be done at an inpatient or outpatient hospital or ASC.

    If you bill with the POS of 21, 22 or 24 the -25 modifier is not appropriate and the claim could be denied. You should use -59 or -51, which ever one is appropriate.

    Hope this helps.

Similar Threads

  1. modifier 50 for anesthesia
    By dsisk in forum Anesthesia
    Replies: 4
    Last Post: 04-28-2015, 09:00 AM
  2. Modifier question for anesthesia
    By beachgrl62 in forum Anesthesia
    Replies: 3
    Last Post: 03-21-2013, 11:29 AM
  3. Anesthesia with Modifier 50
    By lisamalia in forum Anesthesia
    Replies: 3
    Last Post: 11-12-2010, 10:46 AM
  4. Replies: 2
    Last Post: 05-23-2008, 10:14 AM
  5. -53 modifier in anesthesia
    By kamala in forum Anesthesia
    Replies: 0
    Last Post: 04-21-2008, 04:47 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.