Neurology & Pain Management Coding Alert

Question: Can I code bilaterally when injecting both eyes for blepharospasm? Which is correct, modifier -50 or modifiers -LT/-RT?

Iowa Subscriber

Answer: Yes, you can report 64612 (Chemo-denervation of muscle[s]; muscle[s] innervated by facial nerve [e.g., for blepharospasm, hemifacial spasm]) bilaterally to treat blepharospasm. For most payers, you should append modifier -50 (Bilateral procedure) to specify that the physician injected both eyes.
 
Generally, you should apply modifier -50 to report bilateral procedures the physician performs during the same patient encounter or operative session. Modifier -50 applies to surgical (10040-69990) and some diagnostic procedures (e.g., H-reflex studies, 95934 and 95936). Furthermore, you should append modifier -50 only if the CPT code descriptor does not already include the term "bilateral."
 
Modifiers -LT and -RT, meanwhile, designate a procedure the physician performs on one side of paired organs (e.g., ears, eyes, kidneys) or, sometimes (as is usually the case in neurology), paired extremities (e.g., arms and legs). And, you may assign modifiers -LT and -RT if the physician provides a procedure on only one side, as described in the example above.
 
Before deciding on modifier -50 or modifiers -LT/-RT, consult the CMS Physician Fee Schedule Database. If a "1" appears in column S of the database (as with 64612), you may apply modifier -50 for that particular code. A "0" in column S tells the physician and/or coder that Medicare does not allow modifier -50 and, therefore, if he provides the procedure bilaterally, modifiers -LT and -RT are appropriate. A "2" in column S indicates that the code already specifies a bilateral procedure and, therefore, no modifier or payment adjustment is necessary.
 
Note: The fee schedule applies to Medicare only, although other payers may follow it. Check with your payer for guidance.
 
Ultimately, due to nationwide inconsistencies, the best way to know whether modifiers -LT/-RT or -50 is appropriate is to contact your individual carriers. Always be sure to get the payers' coding recommendations and payment guidelines in writing to protect yourself in the event of future audits or claims reviews.
 
Generally, when you report a procedure bilaterally, using either modifiers -LT/-RT or modifier -50, the payer will reimburse at 150 percent of the Physician Fee Schedule relative value unit rate. When billing, do not reduce your fee; allow the payer to make the reduction. Payers should reimburse unilateral procedures with modifier -LT or -RT to denote a specific unilateral location, at the standard rate. If the payer reduces the rate, be sure to appeal.  - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in [...]