Optometry Coding Tip

Question: Do you know how Medicare wants you to bill bilateral OCT?

Keeping straight which diagnostic tests you can report per eye – and which modifiers different carriers prefer for bilateral tests – can be vexing.  Not keeping that information straight can be costly if your claims are denied.

A common cause of denials with your insurance carriers especially Medicare, can be the inappropriate use of modifiers on your diagnostic tests.  Leaving off needed modifiers can also cause underpayment on your claims.

To find out if any CPT code is bilateral or unilateral, check your Medicare fee schedule.  You can find the bilateral indicator in column “Z: (“Bilat Surg”) of the Physician Fee Schedule spreadsheet.

The bilateral indicator can tell you whether a CPT code is billable per eye or only once for both eyes.  It can also tell you whether or not you can append modifier 50 (Bilateral procedure) to a CPT code.