JUL 15, 2022
EHR update automatically adding modifiers
Question: Our electronic health records (EHR) software implemented a new version, and it now automatically adds modifier -25 when the physician performs an extended ophthalmoscopy or OCT. Is this a new rule, and is it correct?
Answer: Modifier -25 is defined as “a significant, separately identifiable evaluation and management service by the same physician on the same day of the [minor] procedure or other service.” Extended ophthalmoscopy, CPT codes 92201 and 92202 and OCTs, CPT codes 92132, 92133, 92134 are testing services and are not included in the scope of modifier -25. Medically necessary testing services are billable with examinations without a modifier.
Additional coding competency resources can be found in
Fundamentals of Ophthalmic Coding.