SEP 10, 2019
Billing Exam for Separate Complaint
Question: Our physician saw an established patient complaining of red and itchy eyes. The Diagnosis is allergic conjunctivitis, and abrasion was found that required debridement. Can we bill the exam and the procedure?
Answer: Although medically necessary, if the established patient exam was performed solely to confirm the need for the debridement, then the exam is not separately billable. However, since the abrasion was separate from the complaint of allergic conjunctivitis, submit the appropriate level of E/M or eye visit code appended with modifier -25 and CPT code 65435 Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage).
Learn more about exam billing in the learn to Code the Essentials.