Ophthalmology and Optometry Coding Alert

Question: How do we code for gonioscopy done in conjunction with evaluation and management (E/M) code 99212? Is it 99212-24 and 92020-59?

Anonymous Michigan Subscriber

Answer: You no longer need to use any modifiers when billing 92020 (gonioscopy [separate procedure]) with eye codes or E/M services codes. Until June 1999, Medicare had bundled this code (as well as 92100 [serial tonometry] and 92060 [sensorimotor examination]) with the eye exam codes (92002, 92004, 92012, 92014). So ophthalmologists were using the E/M codes along with these procedures. Medicare had been on the verge of bundling the E/M services codes with these three procedures as well, but instead decided to let them all be billed separately. Since modifier -59 (distinct procedural service) is used only to break bundles, you would not need it in this case. You would also not need to use modifier -24 (unrelated E/M service by the same physician during a postoperative period), since this is for an E/M service provided during the post-op period. The modifier that many people are tempted to usemodifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service)is not needed either. Just bill 92020 and the office visit. You will get paid for both.