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  • Exam Between Cataract Surgeries

    A patient has cataract surgery on their right eye and comes into the office the next day for their first postoperative appointment. During this appointment, the surgeon planned to go ahead with cataract surgery for the left eye. Can this visit be billed as an evaluation and management (E/M) code (99213) with a modifier 24 due to the complexity of medical decision-making?

    This visit is not separately billable. Confirm your documentation includes an examination of both eyes during the initial visit to determine the need for surgery of the first eye.
    Also review this article Cataract Controversies — Answers to Contentious Coding Questions which shares:
    Q: “Is the interim exam between cata­ract surgeries billable?”
    A: The interim exam involves a post-op visit for the first eye and paperwork for the second. It is billable when the patient has a problem unrelated to the cataract surgery, in which case you would use the ICD-10 code to convey that fact to the payer. It also might be billable if there is a significant change in the status of the eye that warrants further examination. Otherwise, the exam typically is not billable. But what if your documentation indicates that this visit also included an exam that confirmed the need for cataract surgery in the second eye? Would you be able to bill for that exam by use of modifier –24 Unrelated E/M service during global period? No. The Office of Inspector General has stated that such documentation would not justify the use of modifier –24.