ED Coding and Reimbursement Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: A patient in the emergency department needed bilateral chest tubes, and I used 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]) for the procedure code. Should I apply this code only once? Should I append it with modifier -50 (Bilateral procedure) or -51 (Multiple procedures) instead? Maryland Subscriber           Answer: Apply 32002 only once for this procedure, but do not use modifier -51. The thoracentesis code is modifier -51 exempt. Use the bilateral modifier -50 instead.

Modifier -51 indicates multiple procedures by the same physician during the same session. You report the higher-value procedure first and then the lower-value procedure; you add modifier -51 only to the second code. Modifier-51 reduces the second procedure's value by 50 percent; the ED physician already spent time with setup and preparatory work for the first procedure (reimbursed under the first code), so additional procedures don't receive full reimbursement hence, modifier -51. In your case, you should apply modifier -50 to 32002, indicating a bilateral procedure. You usually receive only 150 percent of the single procedure unless your claim goes to Medicare, in which case you could see a range of payments. Medicare has three revenue values for bilateral procedures appended by modifier -50. Ask your local Medicare carrier what payment you should expect from your claim.