Ophthalmology and Optometry Coding Alert

As with other ophthalmology services, the wrong modifier can wreck an AMD claim. Finish your claim with modifiers LT (Left side) or RT (Right side) as appropriate. You might also need to append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) or modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).

You can use modifier 24 if there is another problem thats not related to the surgery, says Becky Zellmer, CPC, MBS, CBCS, medical billing and coding supervisor for Suby, Von Haden and Associates in Neenah, Wis.

Modifier 24 example: The patient sees your general ophthalmologist, has cataract surgery, and sees your  retina specialist during the post-op period for follow-up of wet macular degeneration. The wet AMD is not related to the cataract surgery, so you would append modifier 24.

Modifier 25 time: Modifier 25 is commonly used when the patient comes in for an examination and during the course of the exam, the doctor decides the patient needs an intravitreal injection, says Diane McVinney, CPC, billing manager at the Jones Eye Institute at the University of Arkansas for Medical Sciences in Little Rock. Append modifier 25 to the E/M or eye code to show that the exam and injection were separately identifiable services. This modifier would not be used if the decision to perform the intravitreal injection had been made at an exam performed prior to that day (i.e., the surgery was planned previously).

Youll use modifier 25 if the patient comes in for an examination and it is decided (on that same day) that further testing or a procedure with 10 or fewer global days needs to be performed on that same day, Zellmer adds. My local Medicare carrier just came out with a warning on this, so be very careful.