Ophthalmic Coding Specialist Practice Test

For Medicare Part B patients undergoing bilateral surgery, how should claims be submitted?

1. As two separate line items

2. One line item with modifier -50 appended

3. One line item with modifier -57 appended

4. One line item with modifier -78 appended

The correct answer is: One line item with modifier -50 appended

When billing for bilateral surgery under Medicare Part B, the correct method is to submit the claim as one line item with the modifier -50 appended. This modifier specifically indicates that a procedure was performed bilaterally, which is essential for proper billing and reimbursement processes. By using one line item with the -50 modifier, the healthcare provider clearly communicates to Medicare that the surgery was performed on both sides of the body, which typically deserves a higher reimbursement rate than a unilateral procedure. In this context, using two separate line items would complicate the billing process and could lead to confusion or erroneous payments, as it does not explicitly indicate that the procedures were bilateral. Similarly, modifiers -57 and -78 are used for different purposes; -57 indicates that a decision for surgery was made during the evaluation, and -78 indicates a return to the operating room for a related procedure within a certain time frame. These modifiers do not apply to the circumstances of bilateral surgeries under Medicare Part B, making the choice to use modifier -50 the most appropriate and efficient method for submitting the claim.