Wiki Bilateral x-rays

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ddicrosta

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Hi all. Has anyone gotten denials from Cigna for submitting plain bilateral x-rays with Rt and Lt stating that they need to be submitted on one line with a 50 modifier? i.e. 73562-50 This is contrary to my training as a coder. Does anyone know if new coding students are being trained differently now? I need to know this quickly so I can work this appropriately. Thank you in advance. Dawn
 
Many policies of health plans go against "book" or class training, what other plans, or even CMS does. If they are denying it and telling you it has to have a 50, it does. New students are not being trained differently. Health plans make up their own rules sometimes.
However, if you look up the example code you used above, it is appropriate for Modifier 50. Also, Cigna has a policy about it.
"• 3 - Procedure codes with this indicator are appropriate for use with modifier 50. These are typically non-surgical services (e.g., radiology and some diagnostic testing codes).*Cigna does not allow reporting of bilateral of services on separate claim lines"


Real world coding is totally different than the books and AAPC classes.
 
Thank you for your reply. I've been in coding and billing since 2010 but this is the first time I've come across something like this. I understand that each payer has their own preferences for certain procedures, but no other payer applies a 50 modifier to plain x-rays and will even deny them as incorrect coding unless billed separately with Rt and Lt. I'll see how this plays out. Thank you again.
 
Yes, it seems weird because normally it would be two lines with RT/LT. For most, they tell you to NOT append a 50 to radiology.
 
amyjph said:
Some of the MACs say it can be either way. Example at the bottom of this page/link.
Click to expand...
Thank you again. That is for coding purposes with both being reimbursed at 100%. Cigna is saying that the second side will be reduced by 50% which is totally different. I am waiting to hear back from the people who handle the contracting to see if it's against their contract. I will advise when I know something.
 
ddicrosta said:
my training as a coder. Does anyone know if new coding students are being trained diff
Click to expand...
ddicrosta said:
Thank you again. That is for coding purposes with both being reimbursed at 100%. Cigna is saying that the second side will be reduced by 50% which is totally different. I am waiting to hear back from the people who handle the contracting to see if it's against their contract. I will advise when I know something.
Click to expand...
Hi Ddicrosta (Dawn),

I am experiencing the same problem with Cigna. We updated & billed a corrected claim for 73630-50, because Codify indicates that modifier -50 is allowed with full payment each side (see screen shot.) Unfortunately, Cigna paid the second xray at 50%. Agree, this doesn't seem right, but having a hard time finding reference material to support what Codify says. What did you find out from your team?
BILAT SURG50Allowed, full payment each side


I also just found this link to support 100% payment of each side. Cigna policy also states they follow CMS guidelines, therefore they also follow their indicators. https://www.cms.gov/research-statis...tor of "3,bilateral procedures does not apply.
 
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I have a related problem with Cigna failing to reimburse for an Xray. I have 73562 LT and they WILL NOT PAY. Not bilateral; I learned that lesson a few months ago (50 vs.RT and LT). The agent I spoke to on the phone could not explain what was wrong with the coding. She eventually told me to leave off the LT altogether. Cigna is in my opinion the worst insurance to deal with. I cannot understand the live agents (unlike BCBS) and they have no online chat (unlike UHC). I found no policy on their website that addresses unilateral Xray coding.
 
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