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coding E/M within global for other eye

  1. #1
    Default coding E/M within global for other eye
    Medical Coding Books
    Can I bill an E/M with the appropriate modifier (25) if the decision to do cataract surgery to the other eye is decided during a patient's post operative exam?

  2. #2
    Default
    The decison to perfrom cataract sx, would be a 57 not a 25. If your documentation states the pt was there for an eval of the non-surgical eye and not as a post-op, yes, you could bill for that exam. However, you would want to use a 24 (exam in post-op period) unless you were taking the pt to surgery that day or the next, then you would used both 24 and 57. Some will argue that you would assign the 57 either way because it's the decison for surgery.
    adrianne, cpc

  3. #3
    Default
    Thank you

  4. #4
    Location
    Milwaukee WI
    Posts
    4,466
    Default No 57
    You do NOT need the -57 modifier unless you are performing the surgery that day or the next day. -24 modifier would be used to indicate it is unrelated to the first surgery.

    NOTE ... if you had previously decided you would remove cataracts from both eyes, but were doing them "one-at-a-time" then this is NOT a decision for surgery. It's just deciding when to schedule the second surgery.

    Hope that helps.

    F Tessa Bartels, CPC, CEMC

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