Ophthalmology and Optometry Coding Alert

Question: Are insurance companies allowed to reduce our fees for multiple procedures performed during the same session? Should I reduce the fee before sending the claim? California Subscriber Answer: Many ophthalmic tests are paid at 100 percent each when the ophthalmologist  performs the services bilaterally. The payments are not subject to a reduction. Become aware of what those procedures are and how payers should reimburse for them. Also, keep in mind that you should double a procedure billed with modifier 50 to indicate both eyes to ensure proper claim processing and payment. If you need to apply modifier 51 (Multiple procedures) to a surgical code, then you'll be facing multiple-procedure fee reductions. Many payers, including Medicare, follow a reduced fee policy for multiple procedures performed during the same operative session. Generally, the policy looks something like this: • Procedure 1 is paid at 100 percent of the allowable. • Procedure [...]