Optometry Coding & Billing Alert

Question: We have a patient still in the global postoperative period for cataract surgery. The ophthalmologist performed fundus photography for primary open-angle glaucoma on the patient during his appointment for the post-op follow-up. It is unrelated to post-op, but since it is a diagnostic testing code, do I need a modifier?

Illinois Subscriber

Answer: Medicare always excludes testing procedures from the global surgical package and pays for them separately. No modifier is required. Report 92250 (Fundus photography with interpretation and report) without a modifier.

If the purpose of the visit was to follow up the chronic condition of the glaucoma, and not a post-operative evaluation of the cataract surgery, append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M visit code. Use the ICD-9 code for the type of glaucoma for the claim — in this case, 365.11 (Primary open-angle glaucoma).