Optometry Coding & Billing Alert
Know Carrier Rules for Bilateral Billing
Appending modifier -50 to the wrong diagnostic eye codes can spark denials
Having a list handy of diagnostic optometric procedures that you can - and cannot - bill bilaterally can save your optometry practice from denials and time-consuming resubmissions and appeals.
Carriers usually consider these diagnostic tests to be bilateral procedures, says Regan Bode, CPC, OCS, clinic administrator at the Northwest Eye Clinic in Lynden, Wash.:
Report these codes once, Bode says, with no modifiers to show that one or both eyes were tested. Check with your local carriers, however; some might want you to append modifier -52 (Reduced services) on any bilateral test you perform on only one eye. "They probably won't reduce your payment," Bode says, "but they're going to want to see that you only did the left or right eye."
Carriers consider these diagnostic tests unilateral:
Bill these codes once per eye, Bode says.
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