Ophthalmology and Optometry Coding Alert

Question: Can we ever report modifiers 24 and 25 on the same claim?

Sueprcoder.com Subscriber

Answer: Yes. You can use modifiers 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) and 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) on the same claim, if the physician saw the patient for a completely new or totally unrelated issue within the post-op period, a procedure was done that same day for the unrelated issue, and the evaluation and management (E/M) code is significant and separately identifiable from the procedure.

For example, a patient undergoes major surgery such as a cataract removal (66984, Extracapsular cataract removal with insertion of intraocular lens prosthesis [1 stage procedure], manual or mechanical technique [eg, irrigation and aspiration or phacoemulsification]).

During the postoperative period, the patient comes for an office visit that is absolutely unrelated to the first surgery. It could be that the patient was scheduled for a post-operative visit and during that visit, describes this other problem. The ophthalmologist carves out the information around the unrelated issue in order to bill an E/M level (along with an unrelated diagnosis). At the unrelated E/M visit, the physician also performs a minor surgical procedure, such as a foreign body removal, unrelated to the initial surgical procedure. In this case, you will attach both modifiers 24 and 25 to the E/M code -- modifier 24 to allow payment of the E/M service in the global period of the initial surgery and modifier 25 to allow payment of the E/M service along with another procedure performed on the same day.