• How to Bill for Same Test Performed Same Day


    Question: In the same group practice, the comprehensive ophthalmologist saw a patient for flashes and floaters, then referred the patient to the practice’s retina surgeon. Later that same day, the retina specialist examined the patient, performed extended ophthalmoscopy and did surgery to repair a retinal detachment. What is billable?

    Answer: What was the comprehensive ophthalmologist’s diagnosis?  If the same diagnosis as the retina specialist, only one physician can submit a claim.  As CCI, in July 2013, bundled extended ophthalmoscopy with the surgery, when performed the same day, the practice should submit the appropriate level of E/M or Eye visit code with modifier -57 indicating this is the office visit to determine the need for surgery and the surgery itself. 

    Learn more about CCI bundles in Coding Coach: Complete Ophthalmic Coding Reference and Retina Coding: Complete Reference Guide.