Optometry Coding & Billing Alert

Published on Thu May 05, 2011 PDF

Question: I know that as a general rule the highest RVU has a higher billed amount and that when you bill you should always put the highest amount first. But when it comes to bilateral surgeries is it true that you would sometimes be prudent to put another procedure first because a bilateral code that was done bilateral/unilateral would still be paid at a reduced allowable?

Texas Subscriber

Answer: Yes, you should sometimes put another procedure first. If the 150 percent amount of the relative value units (RVUs) for a bilateral procedure is the highest, you should put that code first.

Here's why: Because the insurer will discount the second and subsequent procedures based on multiple procedure discounts, it's best to list the codes in RVU order, with the highest-paying code listed first. Keep in mind that you should follow this rule of thumb even if your insurer requires you to append modifier 51 (Multiple procedures) before you submit the claim.

Payers will determine your primary and secondary procedures in one of three ways:

• According to the relative value unit (RVU) order based on the Medicare fee schedule
• According to the insurer's own fee schedule
• In the order in which you listed the codes on your claim.