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Old 09-25-2008, 01:08 PM
sgormsen sgormsen is offline
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Question icon mod 50 in CPT

This is my interpretation and need clarification on the 50 icon in cpt.
If the 50 icon is next to the CPT code then it means that this procedure is a "bilateral procedure" and you report it once for both sides with no modifier.
If this 50 icon is not present next to the CPT code then it is considered a "Unilateral" procedure unless the word Unilateral is in the description.
Example: CPT 92225, there is no 50 icon therefore if done on both eyes you would report it with a 50 modifier. The Opthalmology Coding Companion clearly states that this is a unilateral procedure.
Please if someone can clarify this for me I would greatly appreciate it. I think I'm going crazy.

thank you,
Susan Gormsen, CPC
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Old 09-25-2008, 04:24 PM
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dmaec dmaec is offline
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Susan - I don't know what 50icons you're talking about in the CPT book - I don't have any "icons" - I use the CPT 2008 Professional Edition - when the code description says "bilateral" or "bilateral or unilateral" in it - you do not use modifier .50 - what CPT book do you use?

that being said - Bilateral surgery rules do not apply to code 92225 - do not use modifier 50 on 92225. (I guess that leaves you with using LT or RT or units x2)

(per the RVU schedule status indicator #3 in the bilateral surgery column rules)

{that's my opinion on the posted matter}
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Old 09-26-2008, 08:50 AM
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the CPT expert is the book that has the icons
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Old 09-26-2008, 04:37 PM
sgormsen sgormsen is offline
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Donna,
Thank you for you're response.
I use CPT Expert
Susan
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