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sasharea

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If our doctor does a Cataract Surgery on the right eye and the pt is seen in the office during the post op period and the doctor decides to do surgery on the other eye with the same dx can we bill this? I have billed this with a 24 modifier and LT and gotten a denial that says "modifier missing or invalid for this procedure code." I personally don't think this should be billed if this is same dx, but don't know what the right answer is and my doctor wants to know. Could someone please help me with this delima?
 
Medicare states you should wait until after the post-op period before performing surgery on the fellow eye; that said, our physicians do perform the examination for surgery during that period. I think the addition of the eye modifier is the reason for the denial - that should only be on the procedure, not the E/M.

David Keown, CPC, OCS
 
Using a 24 modifier on the E/M should be paid by Medicare if it's within the postop period. You would use the RT or LT on the cataract surgery and add 79 modifier. This is paid in Pennsylvania.
 
sasharea said:
If our doctor does a Cataract Surgery on the right eye and the pt is seen in the office during the post op period and the doctor decides to do surgery on the other eye with the same dx can we bill this? I have billed this with a 24 modifier and LT and gotten a denial that says "modifier missing or invalid for this procedure code." I personally don't think this should be billed if this is same dx, but don't know what the right answer is and my doctor wants to know. Could someone please help me with this delima?
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Yes u would bill cause this is a separate eye using modifier 79 and Lt
SAUKA:)
 
The 24 modifier will get the exam paid. However, the latest Part B newsletter in my region had an articla about what they are targeting for 2012 and the 24 modifier is one the red flags. According to the American Academy of Ophthalmology, in most cases the decision for the second eye surgery was made befoe the first surgery. On their website they state that the only reasons to bill an exam for the second eye during the post op period is if there is a significant change in the second eye or a change in the health of the patient. So you should be sure your doctor is aware of attention the 24 modifier is getting and that his documentation nneds to support billing the exam for the second eye.
 
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