CPT® modifier 25; two distinct E/M services on the same day

An established diabetic patient is scheduled for cataract extraction of a diabetic cataract. He is referred by the ophahalmologist for pre-operative medical evaluation, a standard CYA practice of specialists. The patient is also scheduled for evaluation of the progress of his diabetes; he is undergoing adjustment of his long-acting insulin, under the direct supervision of a visiting nurse. The evaluation of the diabetic regimen is performed with the visiting nurse present; to ensure every on is on the same page of music. After the diabetes conference/review, the nurse leaves and a comprehensive history, review of systems, and physical examination is performed, blood tests and EKG and clotting profile are included in the pre-operative evaluation.
Can I bill for the diabetic follow up visit with 99349 and separately the pre-operative evaluation as 99350 with modifier 25?
If not, how do I get paid for my time and services?

BTW: your discussion of Modifier 25 seems to focus on surgical/procedural services, what about two distinct medical services (E/M) performed on the same day by the same or other physician?

CPT® modifier 25; two distinct E/M

Here is what the Medicare Claims Processing Manual says about two E/M services in the same day:

If more than one evaluation and management (face-to-face) service is provided on the same day to the same patient by the same physician or more than one physician in the same specialty in the same group, only one evaluation and management service may be reported unless the evaluation and management services are for unrelated problems. Instead of billing separately, the physicians should select a level of service representative of the combined visits and submit the appropriate code for that level.

If you submitted both claims, one would be denied initially, I expect. You may get both through with modifier 25, it depends on how the Contractor has their edits set up. You would certainly need two diagnosis codes, two notes. The documentation that supports one of the visits can't be double counted to support the level of service for the other visit.

I doubt they'd pay both high level visits. The catartact pre-ops have minimal medical necessity, so that visit might be better billed at a lower level. Then use the higher level visit for the patient's medical problems. The Contractor will want to see the notes: review the history/exam/MDM requirements for the home visits before you submit.

You might consider, instead, adding a prolonged services code to one E/M service. Since it was not a 100% counseling visit (it doesn't sound like) bill the level of service based on the history/exam/MDM. If it was 99349, the typical time is 40 minutes. In order to use prolonged services code 99354 you must have spent 30 minutes more than the threshold time, so 70 minutes face to face.
If your visit was a 99350, the typical time is 60 minutes, and you would need to have spent 30 minutes more, so your total time must have been 90 minutes to bill 99350 and 99354.