Good Morning,
I am trying to determine what the typical behavior and expectation for reimbursement is on E&M services provided by ophthalmologists in the post-op period for a cataract surgery.
Here's the general scenario:
1. The provider performs surgery to remove a cataract in one eye, perhaps the left to start.
2. The provider sees the patient in the post-op period to check the left eye, however, also checks the right eye, and decides to proceed with cataract surgery for the right eye. The provider schedules the patient a time for the next surgery.
Currently, the payor I work for denies the claim for item number 2, as part of the global for the cataract surgery. Even when the 24 modifier is appended to the claim, it denies through system automatically, as the diagnosis is the same as for the surgical claim.
While it is true that the provider, in item number 2, is doing a post-op evaluation of the left eye, he is actually spending the bulk of his time evaluating the right eye and deciding to move ahead with surgery.
My question, thus, is this a typical practice for a provider to perform both the post-op visit and the evaluation of the other eye at the same time? And if so, does the provider typically receive reimbursement for the portion of the exam that is unrelated to the post-op follow up?
Thanks for any help.
I am trying to determine what the typical behavior and expectation for reimbursement is on E&M services provided by ophthalmologists in the post-op period for a cataract surgery.
Here's the general scenario:
1. The provider performs surgery to remove a cataract in one eye, perhaps the left to start.
2. The provider sees the patient in the post-op period to check the left eye, however, also checks the right eye, and decides to proceed with cataract surgery for the right eye. The provider schedules the patient a time for the next surgery.
Currently, the payor I work for denies the claim for item number 2, as part of the global for the cataract surgery. Even when the 24 modifier is appended to the claim, it denies through system automatically, as the diagnosis is the same as for the surgical claim.
While it is true that the provider, in item number 2, is doing a post-op evaluation of the left eye, he is actually spending the bulk of his time evaluating the right eye and deciding to move ahead with surgery.
My question, thus, is this a typical practice for a provider to perform both the post-op visit and the evaluation of the other eye at the same time? And if so, does the provider typically receive reimbursement for the portion of the exam that is unrelated to the post-op follow up?
Thanks for any help.