Part B Insider (Multispecialty) Coding Alert

Published on Wed Aug 08, 2012 PDF

Question: Is 72200 unilateral or bilateral?

Answer: You should think of 72200 (Radiologic examination, sacroiliac joints; less than 3 views) as a bilateral code.

How you know: Check the bilateral column on the MPFS for 72200. It shows a 0 indicator. That means the usual 150 percent bilateral payment increase doesn't apply. So even if you did append modifier 50 (Bilateral procedure) -- or RT (Right side) and LT (Left side) -- Medicare would pay the "lower of (a) actual charge for both sides or (b) fee schedule amount for single code."