Diagnostic tests are the bread and butter of most optometry practices. But staying on top of 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, however, 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, say experts. Leaving off needed modifiers can also cause underpayment on your claims.
Key: To find out if any CPT® code is bilateral or unilateral, you can check your Medicare fee schedule. You can find the bilateral indicator in column "Z" ("Bilat Surg") of the Physician Fee Schedule spreadsheet.
Checking this bilateral indicator will help you decide how to properly code the work done to assure you’re correctly paid. 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. If you don’t look at the indicator and you use modifier 50 on a code that you can’t use it on, your claim will be denied, and it may be a little unclear why you’re not getting paid, experts advise.
Having expert advice about the hottest optometry topics means you can boost your coding accuracy, decrease denials, and safeguard your payments. That’s why you should keep yourself current with optometry audio conferences.
You’ll find such conference topics as:
Bottom line: You don't have time to weed through the never-ending onslaught of information about orthopedic coding and coverage, so let us do it for you.
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