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Optometry Coding & Billing Alert

Reader Question:

Avoid Modifier 50 for 92010

Question: Is 92020 (Gonioscopy [separate procedure]) inherently bilateral? subscriber

Answer: Most insurance companies, including Medicare, consider 92020 a bilateral procedure code. This means that you cannot report the code twice when your optometrist performs a gonioscopy on each eye.

Billing the service automatically implies that while you performed the service or test on both eyes, you are only allowed to bill one unit.

Although CPT doesn’t specifically describe the procedure as bilateral in the code descriptor, most insurers follow Medicare’s lead. You can find the bilateral surgery indicators in the 2016 fee schedule. Check the column of the database marked “Bilat Surg.” The fee schedule assigns 92020 a bilateral surgery indicator of “2,” which means that Medicare has set the relative value units (RVUs) for gonioscopy based on the optometrist performing the procedure bilaterally.

Tip: If the optometrist performs the gonioscopy on just one eye, your carrier may require you to indicate that the physician did not perform the full bilateral procedure. To do so, append modifier 52 (Reduced services) to 92020.