Ophthalmic Coding Specialist Practice Test

When submitting a claim for bilateral laser iridoplasty for Medicare Part B patients, what is required?

1. Submit two claims separately

2. Submit one claim with code appended by modifier -50

3. Include additional supporting documents

4. Submit as one claim with two line items

The correct answer is: Submit one claim with code appended by modifier -50

Submitting one claim with the appropriate code appended by modifier -50 is correct because modifier -50 indicates a bilateral procedure. In coding, using this modifier allows the billing provider to indicate that the procedure was performed on both sides (in this case, both eyes) without the need to submit separate claims for each side. This practice is particularly relevant for Medicare Part B, which has specific guidelines for coding bilateral procedures to ensure clarity and facilitate the claims process. By appending the modifier -50, the provider can communicate to Medicare that the same procedure was performed on both sides, thus allowing for proper reimbursement for a bilateral procedure under a single claim. The other options, while they may appear reasonable in some contexts, do not align with the established guidelines for bilateral procedures. Submitting two claims separately is unnecessary and creates additional paperwork. Including additional supporting documents is generally not required explicitly for this type of claim submission. Submitting as one claim with two line items would not utilize the modifier effectively and could lead to confusion in processing the claim.