Neurology & Pain Management Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: How should I code an orbicularis oculi (blink) reflex by electrodiagnostic test performed on both eyes? Should I bill 95933 x 2 (once for each eye)? Is modifier -50 necessary?

Arkansas Subscriber

Answer: Code 95933 (Orbicularis oculi [blink] reflex, by electrodiagnostic testing) uses the term "oculi," which refers to both eyes. Therefore, only one unit should be billed to report testing in both eyes. No modifier is necessary. The bilateral recordings should be made with both ipsilateral and contralateral stimulation. If the test is performed unilaterally, modifier -52 (Reduced services) should be appended to 95933.
 
Modifier -50 (Bilateral procedure) should only be appended to a code representing a unilateral procedure that was performed bilaterally (i.e., the modifier should be attached only if the CPT code descriptor does not already include the term "bilateral" or specify multiple sites). As a rule, modifier -50 is appropriate to report bilateral procedures performed during the same patient encounter or operative session and is restricted to surgical procedures (10040-69990) and some diagnostic procedures (e.g., H-reflex studies, 95934 and 95936) when performed bilaterally.
 
One way to check if a code may be reported with modifier -50 is to consult the Physician Fee Schedule. If a 1 appears in column S, modifier -50 is allowed for that code. A 0 in column S tells the physician and/or coder that modifier -50 is not allowed. Therefore, if the procedure is performed bilaterally, modifiers -LT (Left side) and -RT (Right side) are appropriate. A 2 in column S (as is the case with 95933) indicates that the code already specifies a bilateral procedure and that no modifier or payment adjustment is necessary.