Question: A patient came in for a GDX and visual field (VF) tests. During the same visit, the ophthalmologist put in temporary plugs. Can we get paid for all services on the same day? I know the office visit needs a modifier. Do I need to put one on the GDX & VF, too?
Answer: Provided the ophthalmologist made the decision to perform the tests during this visit, you may bill for the office visit and the testing. You should be able to get paid for all services using four modifiers — one on the office visit as you indicated, one on each plug code, and one on the GDX. You do not need a modifier on the VF (92081-92083, Visual field examination, unilateral or bilateral, with interpretation and report …).
Warning: If the patient was scheduled to come in for the GDX and VF testing as the result of a previous office visit, you should bill only the GDX and VF testing.
Unless there is a need for the physician to perform another office visit evaluation (worsening symptoms, new symptoms), do not report the office visit. Inserting a plug (68761, Closure of the lacrimal punctum; by plug, each) is a minor procedure that includes related evaluation and management work. You should only report an E/M when documentation supports the service as significant and separately identifiable from the plug insertion. In these cases, you need modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) on the office visit (99201-99215, Office or Other Outpatient Services).
Make sure to use separate diagnoses for the problem and for the primary reason or diagnosis for the visit. (Please click ‘read more’ for a money-saving tip and how you should code for an insurer...
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