Ophthalmology and Optometry Coding Alert

Question: We saw a patient twice in the same week - on the first visit, the doctor inserted punctal plugs, and we collected for that service with 68761 (Closure of the lacrimal punctum; by plug, each). The patient presented again a few days later to make sure the plugs were properly secure and the patient's dry eyes were better. We got denied for the second visit, which we reported with 99212. Can you advise?

Codify Subscriber

Answer: Because you reported 68761 earlier in the week, any E/M code you use for the next 10 days will be bundled into the initial plug placement payment, because this code has a 10-day postoperative period.

On the other hand, if you perform an E/M service during that ten-day global period for an issue that is unrelatedto the punctal plug insertion, bill the office visit with modifier 24 (Unrelated evaluation and management service by the samephysician or other qualified health care professional during a postoperative period) to indicate it is not inclusive in the global period. Without the use of the 24 modifier, the visit will bundle as global. Modifier 24 typically applies if you meet these rules:

1. The same provider (or a different provider within the same group) who performs the punctal plug insertion performs the subsequent E/M.
2. The patient reports for treatment of the unrelated issue while still in the global period for the punctal plug insertion.
3. The second E/M is unrelated to the punctal plug insertion.

The number of commonly-performed procedures linked to ten-day global periods may surprise you, and include the following, among others:

• 68761:  Closure of the lacrimal punctum; by plug, each 
• 11440: Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less

Therefore, if you perform one of these procedures and you administer an E/M service within the next ten days that's related to the procedure, your insurer will likely bundle the payment for the E/M service into the amount you received for the procedure.

If, however, you perform an E/M that's not related to the procedure, you can use modifier 24 to separate it.