JUL 30, 2019
Unrelated Exam Same Day as Planned Surgery
Question: Our patient, who was scheduled to come today for a YAG Capsulotomy in the right eye, came in with a complaint of blurriness and flashes in the left eye. We did an exam of the left eye and performed the YAG in the right eye. How should we submit?
Answer: The exam should be payable. However, the problem is how to convey to the payer that the exam is not pre-op, which is part of the capsulotomy 90-day global period. Modifier -57 isn’t appropriate because the decision for the surgery had already been made. Modifier -24 isn’t appropriate because you are not in a post-op period. The only option is to have the claim denied and go through the appeals process.
Learn more about modifiers in the Learn to Code the Essentials.