Question 64491 with a 50 or an RT LT

[joanne.simmons@anthem.com]

Are we to bill 64491 with a 50 or an RT LT? This is in reference to an ambulatory surgery center bill. Encoder Pro indicates 50 should not be used, that you are to bill once with an RT and once with an LT. Which is correct for commercial insurance amb surg? Thanks in advance.

 

[bdcoyne8]

Hello!
Encoder Pro is correct. For add-on codes, you are required to bill with RT and LT.

In our Pain and Spine Clinic, we code our MBB's as such.
64490-50
64491-RT
64491-LT
64492-RT
64492-LT

We have not got denials coding this way. I hope this helps!

 

[Prada]

Hello!
Encoder Pro is correct. For add-on codes, you are required to bill with RT and LT.

In our Pain and Spine Clinic, we code our MBB's as such.
64490-50
64491-RT
64491-LT
64492-RT
64492-LT

We have not got denials coding this way. I hope this helps!

Would it be the same way for Provider billing and Ambulatory Surgical center(ASC) billing?

I have seen some denials for ASC, where they flag down even the primary code for 50 mod and we send corrected claims with RT and LT.
Is this true for 64483 /64484 as well?

 

[csperoni]

I only bill for provider, but specifically for add on codes, there was a new guideline starting 2020 that -50 should not be for add on codes. Add on codes should be -RT and -LT.
That being said, as someone who bills a bilateral add on code several times per week, I don't think any of the carriers updated their software for this change. From what I have seen, some carriers always wanted -RT -LT whether add on code or not. If the carrier previously paid as -50 and did not require -RT -LT, they still don't require it for add on codes.
I consider it payor specific, regardless of the CPT guideline for -50 on add on codes.
But the "correct way" for add on codes is only using -RT -LT. For non add on codes, it is carrier discretion. I personally bill -50 unless I know in advance carrier will only recognize -RT -LT or if claim denied with -50.
Hope that helps.

 

[bdcoyne8]

Would it be the same way for Provider billing and Ambulatory Surgical center(ASC) billing?

I have seen some denials for ASC, where they flag down even the primary code for 50 mod and we send corrected claims with RT and LT.
Is this true for 64483 /64484 as well?

It should be the same. We do it the same way for our transforaminal injections as well. The primary's get the 50 and the add-ons get the RT/LT. Again, works for us, but might work in different states and different payors.

 

[joanne.simmons@anthem.com]

Thanks for your response.