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Ophthalmology and Optometry Coding Alert

Reader questions:

Don't Code Fundus Photos Bilaterally for Medicare

Published on Fri Apr 01, 2011

Question: Our new software program instructs us to append modifier 50 to code 92250, but I wanted to double-check. Is it appropriate to use modifier 50?North Dakota SubscriberAnswer: Medicare considers code 92250 (Fundus photography with interpretation and report) to be inherently bilateral. The relative value units (RVUs) for the procedure are already based on the procedure being done bilaterally. Therefore, you should definitely not report the code with modifier 50 (Bilateral procedure) appended. If you do, the carrier will most likely ignore it and just pay for one instance of 92250.If the ophthalmologist only photographed one eye, you may append modifier 52 (Reduced services), along with LT (Left side) or RT (Right side) as appropriate, to 92250 to show that he did not perform the full bilateral service.Modifier 52 is an informational modifier and does not require you to reduce your fee.Do this: Look in the "Bilat Surg" column in [...]
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