Urology Coding Alert

Tip: Determine the best modifier using Medicare's Physician Fee Schedule When your urologist performs a bilateral procedure such as a cystourethroscopy and bilateral double-J stent insertion, you're missing out on reimbursement if you don't append the correct modifier. Use the following expert tips to ensure you're using modifiers LT, RT, and 50 correctly to show payers that your physician deserves additional compensation for the bilateral surgery. Refer to the Fee Schedule for Guidance Before deciding between modifiers 50 (Bilateral procedure) and LT (Left side) or RT (Right side) for a given claim, you should consult the 2006 Physician Fee Schedule database to see if appending a bilateral modifier is even allowable.
 
Look at column "T" of the spreadsheet, labeled "BILAT SURG." If you see a "1," you can use modifier 50 for that particular code and expect to receive 150 percent payment, says Barbara E. Oviatt, CPC, CCS-P, coding supervisor at Martin Memorial Medical Group in Stuart, Fla.
 
Here's how: Submit your claim with the code listed twice, once with modifier 50 and once without, and put modifier RT on one and modifier LT on the other. The payer should then process your claim and pay the urologist a total of 150 percent of the standard payment.
 
But be sure to do this only with those few payers that  process claims this way, because those that follow Medicare processing may pay you 150 percent on the one charge and 100 percent on the other, and when this error is discovered, the carrier will certainly ask for a refund.
 
"Medicare carriers for Part B services have published articles specifying their preference to report a bilateral service with a single line item with modifier 50 and 1 unit of service, whereas [some] non-Medicare payers prefer reporting bilateral services with two line items -- one with RT and 1 unit of service, and the second with LT and 1 unit of service," says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting, a reimbursement consulting firm in Denver. Check with your payer to be sure, because some also require the 50 on the same code on a second line with 1 unit.
 
Example: Your urologist performs a cystourethro-scopy and places ureteral double-J stents bilaterally (52332, Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]).
 
When you find this code in the Physician Fee Schedule database, you notice a "1" in column T, and therefore you should report this procedure as 52332-50 for Medicare because the urologist performed it bilaterally. Avoid Bilateral Modifiers With '0' Indicator If you see a "0" in column T, you should not append modifier 50. "The "0" indicator means that the payment adjustment for a bilateral indicator [...]