Ophthalmology and Optometry Coding Alert

Before you report the bilateral modifiers on your claim, make sure you know whether your eye care services can be reported bilaterally. You can confirm which services are modifier 50-eligible by consulting the Medicare Physician Fee Schedule. Following you can find a sampling of commonly-billed eye care codes and which categories they fall into:

Inherently Unilateral – You Can Append Modifier 50 (Have a “1” in the Fee Schedule):

• 67005 -- Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal
• 67311 -- Strabismus surgery, recession or resection procedure; 1 horizontal muscle
• 67700 -- Blepharotomy, drainage of abscess, eyelid
• 67840-67850 – Removal of eyelid lesion
• 67900 -- Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)  

Inherently Bilateral – Do Not Report Modifier 50 (Have a “2” in the Fee Schedule):

• 92025 -- Computerized corneal topography, unilateral or bilateral, with interpretation and report 
• 92132-92134 -- Ophthalmic imaging
• 92145 -- Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report
• 76514 – Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness)
• 92227 – Remote imaging for detection of retinal disease (e.g., retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral

You Needn’t Append Modifier 50 – Both Sides Paid at 100 Percent (Have a “3” in the Fee Schedule):

• 92225-92226 -- Ophthalmoscopy
• 92230 -- Fluorescein angioscopy with interpretation and report
• 76510-76513 – Ophthalmic ultrasound
• 76529 -- Ophthalmic ultrasonic foreign body localization