Question: We billed E&M code 99203 along with CPT code 65205 Conjunctival foreign body removal. The commercial payer stated the exam was included in the payment for the surgery. Is this correct?

Answer: Not all payers follow Medicare’s guidelines for billing new patients with minor procedures. The commercial payer may do one of two things:

• Require modifier -25 even though it is a new patient;
• Bundle in the exam, since 10 percent of the surgical code is designated for preoperative care.

Check the payer policies to see what it states about billing minor procedures the same day as the exam, especially those with a 0-day global period. If you have a choice between the appropriate level of exam and a minor procedure, evaluate the fee schedule to help you determine which is most appropriate to bill.

Learn more about minor surgeries in Ophthalmic Coding: Learn to Code the Essentials.