Ophthalmology and Optometry Coding Alert

Reader Questions:

Append 2 Modifiers for 2 Bundles

Question: A patient came in during the global period for a procedure on her left eye with a complaint relating to the right eye. The ophthalmologist performed an intra-
vitreal injection on the right eye in addition to the office visit and testing. Because this visit was an exception to the global period, but the E/M service was separate and distinct from the injection, should I append modifier 24 or 25 to 99213?

California Subscriber Answer: You should append both modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) and 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...).
 
You need modifier 24 to separate the E/M service from the global period of the prior surgery, and you also need modifier 25 to show that the E/M service is distinct from the intravitreal injection the ophthalmologist performed that day.
 
You should also append modifier RT (Right side) to clarify to the carrier that the ophthalmologist is not caring for the eye that previously had surgery. On the claim form, report 99213-24-25-RT.
 
Don't miss: Append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to 67028 (Intravitreal injection of a pharmacologic agent [separate procedure]) to show that the injection was also not related to the earlier surgery. Append RT to 67028 as well.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Ophthalmology and Optometry Coding Alert

View All