Ophthalmology and Optometry Coding Alert

Question: How do I determine whether an eye care service can be reported bilaterally? Can you provide a few examples of commonly billed ophthalmology codes and which category they fall into?

Pennsylvania Subscriber

Answer: You can confirm which services are appropriate to bill with modifier 50 (Bilateral procedure) by consulting the Medicare Physician Fee Schedule. Here are a handful of frequently reported eye care codes and the categories they fall into:

Inherently unilateral – You can append modifier 50 to codes with a bilateral indicator of 1 in the fee schedule, such as:

• 67311 (Strabismus surgery, recession or resection procedure; 1 horizontal muscle)
• 67700 (Blepharotomy, drainage of abscess, eyelid)
• 67850 (Destruction of lesion of lid margin (up to 1 cm))
• 67900 (Repair of brow ptosis (supraciliary, mid-forehead or coronal approach))

Inherently bilateral – You cannot append modifier 50 to codes with a bilateral indicator of 2 in the fee schedule, such as:

• 76514 (Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral …)
• 92025 (Computerized corneal topography, unilateral or bilateral, with interpretation and report)
• 92132-92134 (Scanning computerized ophthalmic diagnostic imaging …)
• 92145 (Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral …)

No need for modifier 50 – You do not need to append modifier 50 to codes with a bilateral indicator of 3. Examples of these codes include:

• 76510-76513 (Ophthalmic ultrasound, diagnostic …)
• 76529 (Ophthalmic ultrasonic foreign body localization)
• 92230 (Fluorescein angioscopy with interpretation and report)