Ophthalmology and Optometry Coding Alert

Question: A patient has elevated intraocular pressure (IOP) due to steroids after cataract surgery. Should I bill for that visit within the global period? What about a subsequent visit to determine if the pressure is falling?

Florida Subscriber  
Answer: If the patients elevated IOP is due to steroids administered in conjunction with cataract surgery, you cannot bill for the office visit for the IOP. The visit is clearly related to the surgery, therefore obviating modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period). Likewise, you may not bill a follow-up visit to ascertain that the pressure is dropping that, too, is related to the cataract surgery.
 
If the patient had glaucoma prior to the cataract surgery and you are managing the patients glaucoma at the visit, you can bill for the visit following cataract surgery, using an E/M visit code (99212-99215) with modifier -24. Make sure you link the condition of glaucoma (365-365.9) to the E/M visit to distinguish it from the cataract surgery. Document that the visit focused on managing the glaucoma and was not simply a post-op visit that included a pressure check. You may have to fight to get these visits paid, so make sure you show that the visit was unrelated to cataract surgery.