Wiki 68801-50 Dilation of Lacrimal Punctum

[adpaugel]

Hi all,

This is a current question in our billing office. Medicare states that 68801-LT and 68801-RT need to be billed together using modifier 50. I believe that when billing with modifier 50, we should use 1 unit at 150% the regularly billed rate.

A coworker believes you should use 68801-50 with 2 units at full fee.

Thoughts?

 

[minnick]

68801-50 I believe is correct

 

[CodingKing]

I'm not sure if its true or not but in my modifier training I was told if modifier increases the reimbursement rate to increase the rate on the bill. If modifier reduces, let the payer do the reduction.

 

[adpaugel]

Medicare won't increase the reimbursement rate on their own. So, you would agree that 68801-50, 1 unit, should be 150% the typical charge? Or 1 unit, double the charge? I suppose either way Medicare will adjust down as they see fit.

 

[briansmith99]

Medicare won't increase the reimbursement rate on their own. So, you would agree that 68801-50, 1 unit, should be 150% the typical charge? Or 1 unit, double the charge? I suppose either way Medicare will adjust down as they see fit.

I believe its 1 unit double the charge. You're dilating both punctum so you charge for each service. A typical payment comes at 150% of your contracted amount with most payors likely including Medicare since they will expect you to take a 50% discount figuring you've already been working on the one eye and are now moving to a second.

 

[adpaugel]

Thanks for your input!

 

[mzkandyd]

You ONLY need to use modifier 50. By billing modifier 50 AND x2, its like saying there are 4 units.

 

[adpaugel]

Thanks, I thought so. I was able to locate the MLN Matters on modifier 50, so I'll be presenting that to my supervisor today. Your input is much appreciated!