Part B Insider (Multispecialty) Coding Alert

Published on Fri Jul 25, 2008 PDF

Payer policy reigns when it comes to selecting the right modifier

Question: We performed a bilateral x-ray. Can we append modifier 50 to the code or should we bill it some other way?

Answer: Although some experts advise using modifier 50 (Bilateral procedure) on all bilateral x-ray claims, that isn't always accurate. Although your payer may sometimes require you to use modifier 50 for bilateral claims, this is not true for all bilateral x-ray claims.

Modifier 50 tells the payer that the provider performed a unilateral procedure (described by a unilateral CPT code) bilaterally during the same session.

If a code includes the word "bilateral" in the descriptor, you should not add a modifier to show that the test is bilateral.

Example: Code 73520 (Radio-logic examination, hips, bilateral) includes the word "bilateral" and instructs you that you need two views of each hip to use the code. You should report 73520 without a bilateral modifier to indicate a bilateral service.

But even knowing this isn't enough. You should know how to report the appropriate codes and modifiers when you do report a unilateral code bilaterally.

Option 1: Medicare typically requires you to report the relevant CPT code with modifier 50 on one line only.

Example: You report a bilateral x-ray (73620, Radiologic examination, foot; two views) service to a payer, requiring you to follow this one-line reporting rule.You would submit 73620-50 in this specific one-line scenario.

Option 2: Other payers may instruct you to list the procedure code twice and append 50 to the second code. If this were the case with the example above, you would report 73620 and 73620-50.

Option 3: Still other payers want you to report the code twice, using modifiers RT (Right side) and LT (Left side). This is the most common method for reporting bilateral x-rays, such as 73620-RT and 73620-LT.

Lesson: Get your payers' preferences in writing, and apply them every time.