Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > Ophthalmology/Optometry
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 03-22-2012, 11:29 AM
*3boys *3boys is offline
Contributor
 
Join Date: Apr 2007
Posts: 22
*3boys is on a distinguished road
Default CPT 92226 modifer 50 or RT LT

Which is the correct way to code for 92226. Is one way preferred over another. Thanks in advance.
Reply With Quote
  #2  
Old 03-22-2012, 12:55 PM
OCD_coder's Avatar
OCD_coder OCD_coder is offline
True Blue
 
Join Date: Apr 2007
Location: Nashville AAPC Chapter
Posts: 755
OCD_coder is an unknown quantity at this point
Default

You would have to check via payor preference rules as to whether they want mod-50 or LT/RT. Because this is a medicine code I would be tempted to bill LT or RT as the procedure would be paid at 100% for each procedure - but would be interested in other interpretations.

Here is what supercoder says:

These are unilateral procedures. If performed bilaterally, some payers require that the service be reported twice with modifier 50 appended to the second code while others require identification of the service only once with modifier 50 appended. Check with individual payers. Modifier 50 identifies a procedure performed identically on the opposite side of the body (mirror image).

Here is MCR's instructions:
The usual payment adjustment for bilateral procedures does not apply. If procedure is reported with modifier -50 or is reported for both sides on the same day by any other means (e.g., with RT and LT modifiers or with a 2 in the units field), base payment for each side or organ or site of a paired organ on the lower of: (a) the actual charge for each side or (b) 100% of the fee schedule amount for each side. If procedure is reported as a bilateral procedure and with other procedure codes on the same day, determine the fee schedule amount for a bilateral procedure before applying any applicable multiple procedure rules.
Services in this category are generally radiology procedures or other diagnostic tests which are not subject to the special payment rules for other bilateral procedures.
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 06:08 AM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC