Ophthalmology and Optometry Coding Alert

Question: I am not clear on how to bill pachymetry correctly. Previously, I was able to bill it as two units when performed on both eyes, but now I am getting refund requests from a local carrier.

New Mexico Subscriber

Answer: Report 76514 (Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral [determination of corneal thickness]) without modifiers, regardless of whether the ophthalmologist performed it unilaterally or bilaterally. Code 76514 is a bilateral code. Note the phrase "unilateral or bilateral" in the description; it indicates that carriers will pay the same amount whether the optometrist performs it on one or both eyes.

Your local carrier has probably discovered its mistake in reimbursing you double for the procedure, and you will most likely have to comply with its refund requests.