Wiki 2020 add on codes modifier reporting changes

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StephCodes2

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Hi all, I code for pain management. Our billers are coming to us with an edit issue. With the new CPT changes that rolled out, we can no longer report a -50 modifier on several of the add on codes we use. We've been instructed to instead report 2 units, 1 unit with RT and 1 unit with LT. This hits an MUE.

Example:
64493-50
+64491-RT
+64491-LT

Billing is asking us to try adding a -59 to the 2nd 64491 that we are reporting in hopes to circumvent the edit. Has anyone tried that? I don't see how that would work. Are you appealing all of these? Or appealing the MUE edit specifically? I'm just not even sure how to help.
 
Right now we are trying it with 64491- RT LT on the same line. We haven't gotten any denials as of yet. But I personally do not think it is acceptable to bill the modifier 59 as this is not a separate procedure and those are add on code specific to a primary procedure. We also work in a pain management clinic so you are not alone in the frustrations!!!
 
CMS has not yet updated the MUE values and bilateral surgery indicators on the NCCI and PFS tables to conform with the new CPT guidelines on reporting add-on codes. Because of this, my personal recommendation would be to continue reporting the add-on with the modifier 50 because the reimbursement schedules are still designed to allow this and pay the codes appropriately.

You will not be able to bypass the MUE edit with any modifier and your only resort will be to allow the code to deny and then appeal with medical records, which will cause significant extra work and delays and ultimately not result any different payment (and that's assuming that your appeals are successful, which is not a sure thing by any means). The RT/LT on the same line, as mentioned above, should still hit the MUE edits if billed with 2 units - if you bill it this way but with only 1 unit, then your claim will be underpaid - whereas the modifier 50 with 1 unit will pay the bilateral reimbursement.
 
Last edited:
So glad this question was posted. We were instructed in several webinars to bill with 2 units for the add-on procedure codes. We have already started receiving denials from Medicare on these claims. My revenue cycle manager called Medicare and was advised that we need to report these on separate lines with no modifiers. Im not confident that will work either. If the MUE did not update for 2020 then that would 100% explain why we are getting the denial. I had a hunch it was because the carrier hasnt updated their coding edit software.

This CPT change was across the board on all add-on codes so Im going to assume this issue is just beginning. Hopefully more direction is to come to overcome this.
 
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