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Ophthalmology and Optometry Coding Alert

Reader Question:

Document Problem for Post-Op Exam

Published on Tue Oct 09, 2012

Question: We did a general eye exam at the patient's request within the three-month period after cataract surgery. Another physician had done the surgery and initiated follow-up care. We billed 99212, appending modifier 79, but Medicare rejected the claim. When I called their customer service line, they couldn't tell me which modifier to use -- but they did say it would be 24, 25 or 57. Which one is correct?South Carolina SubscriberAnswer: If you can document that your visit was for a complaint unrelated to the original cataract surgery, you can report the E/M service with modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period). Without the modifier, the insurer will assume that the visit was related to the surgery, no matter what diagnosis you report, since the patient is still technically within the postoperative care period of the cataract surgery. You may need to submit [...]
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