We just went through an audit and was told we need to apply a left or right modifier on joint injection codes 20600, 20605 and 20610. We were told CMS is "wanting" this. Does anyone else do this and if so do you have supporting documentation from CMS? (We already use a 50 when appropriate.) If 10's pass it will be a mute point but for now what is your take?
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Wiki 20600, 20605, 20610 with Lt/Rt modifier
- Thread starter loricpc
- Start date
mitchellde
True Blue
Yes you should always use the the LATERALITY modifiers for services performed only on one side of a bilateral body part or organ. This will not go away with ICD-10 CM. We are not replacing the modifiers with laterality diagnosis codes. We will be matching the codes to the modifiers.
ollielooya
True Blue
Yes, we bill using the anatomical modifiers. If they are not used, MCR will deny...at least NGS will...
I have not seen this being used, but a question has been raised as to whether we need to use RT and LT on therapeutic and/or vaccine injections. For instance, if a PT gets a pneumovax in the rt arm and a flu vax in the lt arm do we add the RT and LT modifiers to their admin codes?
nrichard
Guest
Anatomic Modifiers vs Modifier50
To commercial payers, for bilateral knee injections I bill 20610-LT, and 20610-RT-59. While I know it's not correct coding to use modifier 59 on the second line item, you will get a denial for duplicate code if you don't use it.
For Federal payers the correct way to bill bilateral knees (and this comes from the CMS NCCI manual) is to report one line item of 20610-50 with only one unit.
To commercial payers, for bilateral knee injections I bill 20610-LT, and 20610-RT-59. While I know it's not correct coding to use modifier 59 on the second line item, you will get a denial for duplicate code if you don't use it.
For Federal payers the correct way to bill bilateral knees (and this comes from the CMS NCCI manual) is to report one line item of 20610-50 with only one unit.