Mferbeyre
New
Hello everyone
This is my very first post so please let me know if I am posting this question in the right forum thread...
I work for an ophthalmologist, and there has been some confusion lately with modifier 25 and 57. I have read numerous articles, and printed out papers to try and get a better understanding in plain English lol it seems like these sights and articles love to run around in circles with their explanations of these modifiers and it makes me crazy! Anyway, my question is:
When a major procedure (ex. 66821) and a 92014 are billed on the same date, and the laser has been previously scheduled. Can the two CPT codes be billed together? And would the E/M get a modifier be 25 or 57?
The articles I have printed say that modifier 25 should be used with minor procedures. When the office visit results in a decision for that minor procedure. My understanding of this is if the patient comes in because they have scheduled a minor procedure (ex. 65855), and the doctor sees the patient prior to the surgery, and is also evaluating the patient for other issues... like retinal hypertension or something. Then we would use the -25 on the E/M.
These same articles also say that modifier 57 should be used on the same day or the day before a major procedure and that results in the decision to perform the surgery. My understanding of this is if the doctor sees the patient for cloudiness after cataract surgery, and determines the patient needs a 66821 either that day or the day after, then the -57 would go on the E/M code.
Is my understanding correct?
Or IF the 66821 is scheduled lets say a week in advance then none of these modifiers qualify, and we shouldn't be billing an office visit and a procedure on the same date?
Any and all help would be greatly appreciated
This is my very first post so please let me know if I am posting this question in the right forum thread...
I work for an ophthalmologist, and there has been some confusion lately with modifier 25 and 57. I have read numerous articles, and printed out papers to try and get a better understanding in plain English lol it seems like these sights and articles love to run around in circles with their explanations of these modifiers and it makes me crazy! Anyway, my question is:
When a major procedure (ex. 66821) and a 92014 are billed on the same date, and the laser has been previously scheduled. Can the two CPT codes be billed together? And would the E/M get a modifier be 25 or 57?
The articles I have printed say that modifier 25 should be used with minor procedures. When the office visit results in a decision for that minor procedure. My understanding of this is if the patient comes in because they have scheduled a minor procedure (ex. 65855), and the doctor sees the patient prior to the surgery, and is also evaluating the patient for other issues... like retinal hypertension or something. Then we would use the -25 on the E/M.
These same articles also say that modifier 57 should be used on the same day or the day before a major procedure and that results in the decision to perform the surgery. My understanding of this is if the doctor sees the patient for cloudiness after cataract surgery, and determines the patient needs a 66821 either that day or the day after, then the -57 would go on the E/M code.
Is my understanding correct?
Or IF the 66821 is scheduled lets say a week in advance then none of these modifiers qualify, and we shouldn't be billing an office visit and a procedure on the same date?
Any and all help would be greatly appreciated