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Billing 11441 for right and left eye same day

Polly Posted Wed 16th of May, 2012 14:02:43 PM

We are billing the code 11441 to Medicare for both right and left eye. We submitted on two lines with modifier 50 on the second line. They only allowed one line of the 11441 and denied the other as a required modifier missing. Did we not bill it correctly by billing two separate lines or should we just put the the E2 codes on the two lines?

SuperCoder Answered Wed 16th of May, 2012 18:41:24 PM

Lesion-removal codes (11440-11446), although unilateral, should not be billed with modifier -50 when performed on both eyes. Whether two lesions are removed from one lid, or one lesion from one and one from another, there are still two lesions: Count the lesions, whether they are on one or both eyes.

Contact your carriers for their rules on coding multiple lesion removal. Some want you to use modifier -51 or the eyelid modifiers. Some want both. Two examples demonstrate how a claim for multiple lesion removal should read:

1. A patient with a 0.4-cm benign lesion on the upper eyelid of the right eye and the lower eyelid of the left eye:

Line 1: 11440-E3
Line 2: 11440-51-E2.

2. A patient with a 0.4- and a 0.7-cm benign lesion on the upper right eyelid:

Line 1: 11441-E3
Line 2: 11440-51-E3.

Note: Always list the procedure with the highest reimbursement first when billing multiple procedures because that one is reimbursed at 100 percent.

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