Neurology & Pain Management Coding Alert

Question: Should I append modifier -50 to 95933 when reporting orbicularis oculi (blink) reflex testing on both eyes?

Texas Subscriber

Answer: Code 95933 (Orbicularis oculi [blink] reflex, by electrodiagnostic testing) describes testing of the corneal reflex. The latency of the responses, including side-to-side differences, can aid in localizing pathology in the region of the fifth or seventh cranial nerves or brainstem. The physician should record responses bilaterally with both ipsilateral and contralateral stimulation.

The Physician Fee Schedule assigns a bilateral procedure modifier of "0" to 95933, indicating that bilateral adjustment is inappropriate "because of physiology or anatomy, or because the code description specifically states that it is a unilateral procedure and there is an existing code for the bilateral procedure." Therefore, you should not append modifier -50 (Bilateral procedure) with 95933, nor should you bill multiple units for bilateral testing. Report a single unit of 95933 for either unilateral or bilateral testing.

Note that testing as described by 95933 contains both a professional and technical component. If the physician interprets the test only, append modifier -26 (Professional component) to 95933. The facility will bill separately for use of equipment, staff, etc.