Neurology & Pain Management Coding Alert

Location modifiers increase specificity, but consult the fee schedule first

Modifiers -LT and -RT and modifier -50 provide similar functions - and you can easily confuse them - but they are not interchangeable. To aid in your selection of these modifiers, follow these three pointers. 1. Consult the Physician Fee Schedule Database Before deciding on modifier -50 (Bilateral procedure) or modifiers -LT (Left side)/-RT (Right side), you should consult the CMS Physician Fee Schedule Database.
 
If a "1" appears in Column "T" of the fee schedule, modifier -50 is allowed for that particular code.
 
A "0" in Column "T" tells the physician and/or coder that modifier -50 is not allowed and, therefore, if the neurologist performs the procedure bilaterally, modifiers -LT and -RT are appropriate.
 
A "2" in Column "T" indicates that the code already specifies a bilateral procedure, so you should not attach a modifier to these codes or expect payment adjustments for a bilateral procedure.
 
Examples: The fee schedule database assigns a 1 indicator to column T for H-reflex studies 95934 (H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle) and 95936 (... record muscle other than gastrocnemius/soleus muscle).
 
This means that you may append modifier -50 if the neurologist provides a bilateral H-reflex study. You should report the procedure using one code as a single line item on the CMS-1500 claim form (in other words, 95934-50, not 95934, 95934-50).
 
In a second example, the fee schedule assigns a 2 indicator to column T for visual evoked potential 95930 (Visual evoked potential [VEP] testing central nervous system, checkerboard or flash). These means that the code already describes a bilateral procedure, and you should not append a modifier if the neurologist indicates she tested both the right and left eyes.
 
Tip: You can download the Physician Fee Schedule Database free from the CMS Web site www.cms.gov. Use the "search" function to find "2004 Physician Fee Schedule."
 
2. Apply -LT/-RT to Increase Unilateral Specificity If the neurologist performs a procedure on one limb or paired organ, you can use modifiers -LT/-RT to make your claim more specific, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.
 
Examples: If the patient has a suspected diagnosis of carpal tunnel syndrome (CTS, 354.0) in the left wrist, and the neurologist performs EMG on one extremity only (the left arm), you should submit 95860 (Needle electro-myography; one extremity with or without related paraspinal areas) with modifier -LT attached.
 
As a second example, when treating a patient for CTS, a neurologist may apply a splint to the affected wrist(s). You should report splint application using 29125 (Application of short arm splint [forearm to hand]; static) or 29126 [...]