MAR 01, 2020
Surgery Rejection With Modifier -24
Question: One day post-op following cataract surgery on a Medicare patient, the surgeon performed bilateral punctal occlusion with plugs. We billed the appropriate level of exam with modifier -24, indicating the exam was unrelated to the cataract surgery, but the claim was denied. Is there another modifier we should submit?
Answer: Although the exam is unrelated to the surgery, if the exam is performed solely to confirm the need for punctal occlusion, it does not meet the definition of modifier -25. Therefore, the exam — even with modifier -24 — is not billable. Submit 68761 -50 -79 and a 1 in the unit field for bilateral punctal occlusion. Modifier -79 indicates the minor surgery is unrelated to the cataract surgery.
Learn more about modifiers in Learn to Code the Essentials.