Ophthalmology and Optometry Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: In the office, our ophthalmologist performed both a nasal and temporal pterygium with no graft, in the same eye. Should I code this as 65420 x 2 or 65420 with a modifier, or are they bundled in the NCCI edits? Arizona Subscriber

Answer: Unfortunately, no modifiers indicate location within the eye. If you bill 65420 twice on the same day, you will more than likely receive a duplicate-claim denial for the second line. If you are billing Medicare, you can append modifier -22 (Unusual procedural services) for greater service, provide a concise statement about how the service differs from the usual, and include an operative report with the claim. If you are billing an insurance company other than Medicare, you can try to send the claim directly into review with a cover letter and on operative note. You should bill 65420 on the first line and 65420-51 (Multiple procedures) on the second line.