Neurosurgery Coding Alert

Realize $430 more for bilateral laminotomy with the correct modifier You're not alone if you find it difficult to distinguish among modifiers -LT and -RT and modifier -50. Fortunately, with the aid of the Physician Fee Schedule database and our experts' advice, you can select an appropriate modifier with confidence. Turn to the Fee Schedule for Guidance Before deciding between modifier -50 (Bilateral procedure) and modifiers -LT (Left side) or -RT (Right side) for a given claim, you should consult the 2004 Physician Fee Schedule database.

If you find a "1" in column "T" (labeled "BILAT SURG") of the fee schedule database, you may use modifier -50 for that particular code.

Example: The surgeon performs a bilateral lumbar laminotomy (63030, Laminotomy [hemilaminectomy], with decompression of nerve root[s], including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar [including open or endoscopically assisted approach]).

When you find this code in the Physician Fee Schedule database, you notice a "1" in column T, and therefore you report the procedure 63030-50. Because most payers reimburse bilateral claims at 150 percent of the assigned fee schedule amount, you can expect an additional $430 for this procedure (for a total payment of $1,290, based on national average payment using 2004 fee schedule figures).

A "0" in column T tells you that modifier -50 is not allowed. You may report modifiers -LT or -RT, however, either in combination or singly, to enhance the specificity of your claim.

Example: Tendon sheath and trigger point injections (20550-20553) contain a "0" in column T, meaning that you may not append modifier -50 to these procedures. But if the surgeon provides several injections to the right wrist and several more to the left wrist, you can report the injections using 20550-RT (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar "fascia"]) and 20550-LT, says Allison Waxler, practice management policy analyst at the American Academy of Physical Medicine and Rehabilitation.

This is a more effective method than simply reporting 20550 x 2 because payers might reject the second unit as a redundant (repeat) procedure. By specifying -RT and -LT, you clearly demonstrate injections to two different anatomic locations.
 
Note: To further demonstrate the separate nature of the injections sites, you should also append modifier -59 (Distinct procedural service) to the second unit of 20550. Don't Expect to Use -50 or -LT/-RT With All Codes If you don't find a "1" or a "0" in column T of the fee schedule database, you should append neither modifier -50 nor modifiers -LT/-RT.

A "2" in column T of the database indicates that the code already specifies a bilateral procedure and, therefore, you should not append a modifier to denote a bilateral procedure. Often, such [...]