Ophthalmology and Optometry Coding Alert

 Modifier 50 can bring your practice 150 percent of the fee schedule amount You could be missing out on major reimbursement for bilateral claims if you're not clear about when to apply modifier 50 or the anatomical descriptors LT and RT. Let us walk you through the do's and don'ts of the Medicare Physician Fee Schedule database to help you select the appropriate bilateral or unilateral designation with confidence. How to Use 50 Properly Before you decide between modifier 50 (Bilateral procedure) and modifiers LT (Left side) or RT (Right side) for a given claim, you should consult the 2007 Physician Fee Schedule database, which is available on the CMS Web site at www.cms.hhs.gov/providers/pufdownload/rvudown.asp. If you find a "1" in column "T" (labeled "BILAT SURG") of the fee schedule database, you can append modifier 50 to the code. "An indicator 1 tells you the payer will reimburse you 150 percent for bilateral procedures -- 100 percent for the first eye and 50 percent for the second," says Nancy LaVergne, CPC, OCS, CAPPM, coder for Jackson Eye Associates in Missouri.
 
Example: Your physician removes lesions from both eyelids involving more than the skin. You should report eyelid lesion removal code 67840 (Excision of lesion of eyelid [except chalazion] without closure or with simple direct closure).
 
When you find this code in the fee schedule database, you'll notice a "1" in column T, and you can therefore report 67840 with modifier 50 attached to it because your physician performed a bilateral procedure.
 
Bonus: You can expect most payers to reimburse bilateral claims at 150 percent of the assigned fee schedule amount, says Lisa Center, certified professional coder with Mount Carmel Regional Medical Center in Pittsburgh, Kan. LT and RT May Apply if Column T Lists a '0'  A "0" in column T tells you that you cannot use modifier 50. You may report modifiers LT or RT, however, either in combination or singly, to make your claim more specific. CPT added the anatomic-specific modifiers RT and LT "to streamline the claims processing system, to allow for automated payment without having to request additional documentation to rule out duplicate or other inappropriate billing," according to the January 2000 CPT Assistant. Don't Expect to Use 50 or LT/RT With All Codes While a "1" in column T allows you to append modifier 50, a "0" indicates that bilateral adjustment does not apply, either because of physiology/anatomy or because the code is unilateral and there is a different code for the bilateral procedure, coding experts say.
 
A "2" in column T of the database indicates that the code already specifies a bilateral procedure, says Melissa Woods, CPC, coder and biller with Advanced Eye Care [...]