Ophthalmic Coding Specialist Practice Test

When coding for add-on codes in strabismus surgery, is it appropriate to use modifier-51?

1. Yes, always

2. No, it may cause payment issues

3. Only for certain procedures

4. Yes, for accurate reimbursement

The correct answer is: No, it may cause payment issues

In the context of coding for add-on codes in strabismus surgery, using modifier-51 is generally inappropriate as it can lead to payment issues. Modifier-51 is typically used to indicate that multiple procedures were performed during the same session. However, with add-on codes, which are specifically designed to be used with primary procedure codes, applying modifier-51 can create confusion for payers and often results in a denial of payment or reduced reimbursement. Add-on codes allow practitioners to report specific additional aspects or procedures related to the primary procedure without needing to append modifier-51. The use of these codes alone accurately reflects the complexity of the surgical intervention and is structured to ensure that proper payment is made for the work performed. Therefore, the correct approach is to avoid using modifier-51 with add-on codes, particularly in the context of strabismus surgery. This adheres to coding guidelines that recommend handling add-on codes distinctly to optimize reimbursement and maintain compliance.