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Optometry Coding & Billing Alert

You Be the Expert: Irrigation and Duct Probe


- Published on Wed, May 11, 2005

Question: Can an optometrist bill for irrigation and duct probe? If so, how would I code for the procedure?


Pennsylvania Subscriber


Answer: Assuming it is within the scope of practice for your state, you can provide and bill for irrigation and duct probe. The CPT code is 68810 (Probing of nasolacrimal duct, with or without irrigation).

Medicare views this surgery code as a unilateral service, which means that carriers will apply a 150 percent payment adjustment for bilateral services. If you probe and irrigate the ducts on both sides, and report the service bilaterally (for example, on one line with a "2" in the units field or on two lines with -LT and -RT modifiers appended), carriers will pay you the lower of:
 

  •  150 percent of the fee schedule amount for a single code (in this case, 5.67 nonfacility RVUs multiplied by the conversion factor 37.8975 = $214.88; 150 percent of that is $322.32, unadjusted), or
     
  •  your total actual charge for both sides.

    Translation: Charge your full fee for both sides. If it needs to be adjusted downward, Medicare will do it for you. However, you need to be sure both sides need the procedure. It is tempting to do both eyes automatically, so document carefully.



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