Ophthalmology and Optometry Coding Alert

Modifiers are they key that can, in some cases, unlock double the reimbursement. Most ophthalmology practices perform dozens of diagnostic tests per week. But staying on top of which diagnostic tests you can report per eye -- and which modifiers different carriers prefer for bilateral tests -- can be vexing. Not keeping that information straight, however, can be costly if your claims are denied. A common cause of denials with your insurance carriers, especially Medicare, can be the inappropriate use of modifiers on your diagnostic tests, say experts. Leaving off needed modifiers can also cause underpayment on your claims. Key: To find out if any CPT® code is bilateral or unilateral, you can check your Medicare fee schedule, says Sylvia Conrad, insurance coordinator with Your Eye Solution in Jacksonville, Fla. You can find the bilateral indicator in column "Z" ("Bilat Surg") of the Physician Fee Schedule spreadsheet. Checking this bilateral indicator will [...]