Ophthalmology and Optometry Coding Alert

Question: My doctor just started performing corneal pachymetries. When billing an eye exam with a corneal pachymetry, do I need to append modifier -25 to the exam? My central billing office says I should, while I don't think it's necessary.

Minnesota Subscriber

Answer: If the ophthalmologist is performing 76514 (Ophthalmic ultrasound, echography, diagnostic; corneal pachymetry, unilateral or bilateral [determination of corneal thickness]) in the office, you should not have to append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.

Don't forget: When code 76514 replaced Category III code 0025T in 2004 for pachymetry, the description of the code changed as well. The previous description of the service included the language "with interpretation and report," a clear indication to physicians that they needed to document the professional portion of the service, the interpretation. The new code and description do not indicate that an interpretation and report are required.

For 76514, the Medicare fee schedule values the service with a technical component and professional component, which means you must document both components to accurately bill for the entire service. Append modifier -26 (Professional component) if the ophthalmologist only read and interpreted the report; append modifier -TC for the technical component.