AUG 17, 2022
Interim Exam Between Cataract Surgeries
Can I bill for an interim exam between cataract surgeries?
Answer: 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 Department of Health and Human Services’ Office of Inspector General has stated that such documentation would not justify the use of modifier –24
This and other cataract controversy questions are answered in Feb. 2022 Savvy Coder.
Cataract Controversies—Answers to Contentious Coding Questions