Ophthalmology and Optometry Coding Alert

Reader Questions:

Examine This Expert Advice on Appending Modifier 51

Published on Thu Jun 22, 2023

Question: There has recently been a disagreement in our department regarding modifier 51 for diagnostic imaging. We billed out 92083 and 92133; I don’t think diagnostic imaging, such as 92133, needs modifier 51 since it’s more of a “surgical modifier.” But I can’t find anything to support that. Should we use modifier 51 on 92133?

Arizona Subscriber

Answer: Technically, modifier 51 (Multiple procedures) is a valid modifier for 92133 (Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve).

Medicare defines modifier 51 as being used for multiple surgeries or procedures, specifically:

Multiple surgeries performed on the same day, during the same surgical session.
Diagnostic imaging services subject to the multiple procedure payment reduction that are provided on the same day, during the same session by the same provider.

So, it’s possible that if your ophthalmologist has access to the equipment, modifier 51 may be appropriate for some of those diagnostic imaging services.

However, you should append the modifier with caution. Several Medicare Administrative Contractors (MACs), including Novitas Solutions, advise coders not to use this modifier because their claims software will append it automatically to the correct procedure code, as appropriate. If the payer’s system recognizes and accepts multiple procedures without the modifier, then it will kick back the claim if the modifier is present.

Resources: www.novitas-solutions.com/ webcenter/portal/ MedicareJH/pagebyid?contentId=00144532, www.wpsgha.com/wps/portal/mac/site/claims/guides-and-resources/modifier-51/.