Ophthalmology and Optometry Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: When filing for 68811 on both eyes, what is the best way to code it? I have used 68811-50 but Im not sure if my units should be one or two.

Anonymous New York Subscriber


Answer: If 68811 (probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia) is done bilaterally, then you should use modifier -50 with one unit to bill Medicare. Modifier -50 indicates a bilateral procedure, so using two units would be redundant. The procedure would be coded 68811-50 and the Medicare reimbursement will be 150 percent of the Medicare fee schedule. This is a minor procedure so there are only 10 days of follow-up included in the global surgery package. If you are billing a payer other than Medicare, you should list this as a two-line item: 68811 and 68811-50. This is because most other payers have set their computers up to handle a single-line item with the -50 modifier by paying 50 percent of their fee schedule and not
150 percent.