Ophthalmology and Optometry Coding Alert

When a patient presents with increased intraocular pressure (IOP) during the postoperative period, the visit is not billable without a complaint because it is covered by the global fee for the surgery. Ophthalmologists can be reimbursed, however, for subsequent visits to check on the pressure by using modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period) and a diagnosis code different from the surgery.

A typical scenario is a patient who had cataract surgery and comes to the ophthalmologists office the next day for a postoperative visit. The patient has no complaints, but upon checking the IOP, the ophthalmologist determines it is elevated. If this patient did not have glaucoma previously, the physician would not charge for the visit, says Jon Winders, clinic coordinator for Umpqua Valley Eye Associates, an ophthalmology practice in Roseburg, Ore., noting that it is common to check pressure after cataract surgery as part of the normal followup. In that example, the physician may ask the patient to come back in a couple days or a week to check the pressure again. This second visit would be billable because it is no longer routine postoperative care, Winders says. The ophthalmologist should append modifier -24 to the established patient office visit code (99211-99215) to indicate that the visit is not included in the global surgery package.

The diagnosis code should also reflect something different from the one given for the cataract surgery, such as open angle with borderline IOP or cupping (365.01) for suspected glaucoma, Winders says.

The ability to charge for the visit is driven by the chief complaint and the reason for the visit, Winders says. If we called the patient back for a postoperative check after the surgery, and the patient had no complaints, we wouldnt bill for the visit.

If the surgery had been a trabeculectomy (65855, trabeculoplasty by laser surgery, one or more sessions) the surgeon would not be able to bill for any elevated pressure during the postoperative period because it is a glaucoma-related procedure. Youre checking the effectiveness of the laser procedure on the pressure, and any postsurgical elevated pressure would be related to the surgery, Winders says. You cant bill for that office visit.