Ophthalmology and Optometry Coding Alert

Question: How should we code an orbital foreign body X-ray that involves one PA view for both orbits?

Colorado Subscriber

Answer: While the code description in 70030 (Radiologic examination, eye, for detection of foreign body) does not indicate unilateral, you can confirm that it’s inherently unilateral by having a look at its bilateral surgery indictor of “3” in the Medicare Physician Fee Schedule (MPFS). A bilateral surgery indicator of “3” is designated exclusively for radiological procedures that have bilateral billing eligibility but are considered unilateral without a bilateral-indicating modifier.

In this instance, the fact that one view was taken should not deter you from coding the procedure as bilateral so long as the dictation report supports as much. This does not necessarily require two distinct reports, but rather documentation that both orbits were screened prior to the magnetic resonance imaging (MRI) scan. Furthermore, submitting this code to Medicare or a commercial payer without a modifier indicating laterality will likely result in a denial. However, it’s also incorrect to append either modifier LT (Left side) or RT (Right side) to an inherently bilateral procedure. Therefore, your best course of action is to submit the claim with modifier 50 (Bilateral procedure) when the interpretation report clearly documents the imaging of two orbits.