Cardiology Coding Alert

Question: One of the coders in our office is reporting two units of 36245-50 for bilateral services. I always thought you should use a single unit with modifier 50. Which method is correct?

Utah Subscriber

Answer: Reporting two units of a code and appending modifier 50 (Bilateral procedure) will equal reporting four services, which is incorrect. The correct method of coding bilateral 36245 (Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family) services will depend on your payer's preference.

Some payers prefer that you report your procedure code only once, one unit, with modifier 50 appended (36245-50). Other payers want the code reported using two line items, one unit each, with modifier LT (Left side) attached to one and modifier RT (Right side) attached to the other (36245-LT, 36245-RT), or payers may have another preference.

Fee facts: The Medicare Physician Fee Schedule lists a "1" indicator in the bilateral surgery column for 36245. That means if you report two of the services on the same day (whether with two units, modifier 50, or some other way), the contractor will pay either the actual total charge for both sides or 150 percent of the fee schedule amount for a single code, whichever is lower, according to the "National Physician Fee Schedule Relative Value File Calendar Year 2010."