General Surgery Coding Alert

Question: My surgeon frequently performs bilateral ligations or biopsies of the temporal artery. Although 37609 does not indicate multiple arteries, according to the CMS fee schedule it cannot be billed bilaterally. How should I code this to get reimbursed for both sides?

Indiana Subscriber  
Answer: Temporal artery ligations are typically performed with biopsy. Such biopsies are usually performed when the patient has pain in the temple or blindness in an eye and, therefore, most surgeons perform them on one side (the symptomatic, or ipsilateral side) only.
 
If the surgeons documentation shows the medical necessity for performing the ligation/biopsy on both sides, bill the procedure with modifier -59 (distinct procedural service) attached to the second code. Some carriers may prefer modifiers -LT (left side) and -RT (right side). The documentation should indicate that the procedure was performed on a separate site and required a separate incision.
 
Note: The Medicare fee schedule does not permit 37609 (ligation or biopsy, temporal artery) to be billed with a -50 (bilateral procedure) modifier.