Do I add modifier 50?

[pajohnson]

When you are billing say 64445 and Medicare states that the bilateral surgery indicator is “1”. Thus it means unilateral. So if the Dr does bilateral injections should the unit be billed as 1 or 2? And if this is billed as 1 does the modifier 50 need to be added....

Please clarify, I want to be sure I am billing these injections to Medicare correctly.

Thanks for your help,

[jgf-CPC]

When cannot use the 50 mod we use left and right for Medicare for bilateral procedures.

[ollielooya]

Check your MCR contractor guidelines, as you have two choices. One, you can bill one line with your code appended with modifier 50. You will use (1) unit, (not 2) or Two Bill with two separate lines with RT and LT and modifier 50 on the second line. You will use one unit for each line. We didn't use the second way, but this is my understanding of how it can be billed. If my understanding of the second way is incorrect, our colleagues will jump in here to set things straight. But again, check with your contractor to see their preferred way of notating this on the claim form. It's always worth digging around in their websites to find these type of answers ---Suzanne E. Byrum CPC

[pajohnson]

Thank you very much. Some of my co-workers are trying to bill 2 units and the claims are
gettting denied. I was just wanting some clarification before I have a meeting on how to
bill these injections correctly.

Thanks again,

[mitchellde]

Originally Posted by ollielooya

Check your MCR contractor guidelines, as you have two choices. One, you can bill one line with your code appended with modifier 50. You will use (1) unit, (not 2) or Two Bill with two separate lines with RT and LT and modifier 50 on the second line. You will use one unit for each line. We didn't use the second way, but this is my understanding of how it can be billed. If my understanding of the second way is incorrect, our colleagues will jump in here to set things straight. But again, check with your contractor to see their preferred way of notating this on the claim form. It's always worth digging around in their websites to find these type of answers ---Suzanne E. Byrum CPC

You cannot bill RT and LT on the same line item you must have two lines, one with Lt and one with RT. You would not use a 50 at all if you are using LT and RT it is one or the other but never both.

[ollielooya]

Deborah, thanks for your correction!!! After re-reading my post I realized that modifier 50 WOULD NOT be APPROPRIATE with the RT and LT as furnished in the second example. I should have better proof-read my reply and hope it did not cause the original poster any grief. I've been having a "premonition" that I may have advised incorrectly and you jumped to the rescue. Thanks for your alertness!!! Wish my original response could be deleted! ---Suzanne E. Byrum CPC