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Ophthalmology and Optometry Coding Alert

Clarification:

Modifier 50 Won't Work on All Bilateral Claims

Published on Thu May 28, 2009

An article in Ophthalmology Coding Alert Vol. 12, No. 3, "Prevent Uni-Bi Reporting Errors With This Expert Insight," recommends billing 92135 (Scanning computerized ophthalmic diagnostic imaging, posterior segment [e.g., scanning laser] with interpretation and report, unilateral), if performed on both eyes, by appending modifier 50 (Bilateral procedure) with "2" in the units field. For some Medicare carriers, that is the correct coding. For example, Palmetto GBA specifies that to receive full bilateral reimbursement for all codes that, like 92135, are marked with bilateral indicator "3" in the Medicare Physician Fee Schedule, "the days/units (quantity billed) field must reflect '2' even when submitting CPT Modifier 50 or when submitting HCPCS modifiers RT and LT on the same detail line." However: Some carriers disagree. For example, WPS Medicare says, "An indicator of '3' indicates the usual payment adjustment for bilateral procedures does not apply. If the procedure is reported with a modifier [...]
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