ED Coding and Reimbursement Alert
92012 and Modifier -25
Question: Does modifier -25 apply only to E/M codes with Medicare or does it also apply to a 92012 code for a Medicare patient?
Robert Bellinoff
El Dorado Hills, Calif.
Answer: In the scope of the 92012 (ophthalmological services: medical examination and evaluation, with initiation or continuation of diagnostic and treatment program; intermediate, established patient) CPT code description it states that, along with the medical examination and evaluation, initiation or continuation of a diagnostic treatment program can be performed. If an ophthalmologic procedure is done separately from the 92012 code, it should be reported in addition to 92012. You should use modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) only for evaluation and management (E/M) codes.
ED Coding and Reimbursement Alert
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