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While coding for your ophthalmology practice, you may sometimes find yourself bowled over by questions such as these: Question: Our just-new program guides us to add modifier 50 to code 92250; but then I wanted to be doubly sure. Is it proper to use modifier 50? Answer: Medicare considers code 92250 (Fundus photography with interpretation and report) to be inherently bilateral. The relative value units (RVUs) for the procedure are already based on the procedure being done bilaterally. As such, you should certainly not report the code with modifier 50 (Bilateral procedure) added to it. If you so, the carrier will most likely ignore it and just pay for one instance of 92250. If the ophthalmologist only photographed one eye, you may add modifier 52 (reduced services), along with LT ((Left side(/) or RT (Right side) as proper to 92250 to show that he did not perform the full bilateral service. Modifier 52 is an informational modifier and doesn't require you to reduce your fee. Try this: Take a look in the 'Bilat Surg" column in the Physician Fee Schedule' to see if Medicare assumes a procedure is bilateral. For 92250, there's a "2" in that column, which means that the payment adjustment for a bilateral procedure doesn't apply. A "0" or a "3" in that column would also indicate no bilateral payment, whereas a "1" would tell you that you are free to add modifier 50. For more on this and for other specialty-specific articles to assist your ophthalmology coding, sign up for a good medical coding resource like Coding Institute.
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