Orthopedic Coding Alert

Realize $430 more for bilateral laminotomy with the correct modifier You're not alone if you have difficulty distinguishing among modifiers -LT, -RT and -50. Fortunately, with the aid of the Medicare Physician Fee Schedule database and our experts'advice, you can select an appropriate modifier with confidence. Turn to the Fee Schedule for Guidance Before you decide 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, which is available on the CMS Web site at www.cms.hhs.gov/physicians/ pfs/#2004. If you find a "1" in column "T" (labeled "BILAT SURG") of the fee schedule database, you can append modifier -50 to the code. Example: The orthopedic surgeon performs a bilateral lumbar laminotomy (63030, Laminotomy [hemilaminecto-my], 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]). Column T Shows a '1'? You Can Append -50 When you find 63030 in the Physician Fee Schedule database, you'll notice a "1" in column T, and you can therefore report 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).

"Depending upon payer rules, you will either have to list the procedure twice and append modifier -50 to the second procedure or only list the code once with the bilateral modifier appended," said Deborah Berry, CPC, during her presentation, "Modifiers, the Key to Reimbursement," at the American Academy of Professional Coders'2004 national conference in Atlanta. -LT and -RT May Apply if Column T Lists a '0' A "0" in column T tells you that you cannot use modifier -50. You may report modifiers -LT or -RT, however, either in combination or singly, to enhance your claim's specificity. Example: Tendon sheath and trigger point injections (20550-20553) contain a "0" in column T, meaning you should not append modifier -50 to these procedures. But if the orthopedic surgeon administers 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.

If you simply report 20550 x 2, 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. CPT added the anatomic-specific modifiers -RT and [...]