Wiki 69209 and 69210 Modifier 50 or LT RT

[mlync77]

I work for a large Pediatric group and we have had challenges billing 69209 and 69210 bilaterally. The CPT book indicates to use modifier 50 which we use along with modifier 25 on the office visit but we receive "part of primary" denials from insurance. I have read several articles online indicating that we should bill with modifier LT and RT modifier opposed to modifier 50. I am trying to determine if we should be billing modifier 50 or LT RT. Thanks for your help!

 

[bjmontana]

Some insurance do not cover 69209 - they do consider it inclusive of primary procedure. We use mod 50 for bilateral and have not had issue getting processed.

 

[swetap]

69210 WITH LT AND RT MODIFIER OR 59 MODIFIER
69200 WITH 50 MODIFIER
IT MAY BE WORKING WITH INSURANCE.

 

[lgardner]

Medicare does not want a modifier on 69210. At all. (other insurances might take -50/RT/LT).
depending on insurance, 69209 could be billed with a -50/LT/RT modifier.

-59 would not be appropriate. since there is only one procedure being done.

 

[vijaydass35239@gmail.com]

for cpt 69209 coverage is Medicare can we bill RT/LT/50

 

[beulastella]

Both ears – same method (ex instrumentation) > 69210 RT + 69210 LT> Do not use modifier 50.

Same ear – both irrigation & instrumentation > code 69210 only> 69209 is bundled into 69210 per NCCI edits.

Different method each ear > 69209 LT, 69210 RT

 

[zacklightsey]

Medicare does not pay 69209 with a laterality modifier. I'm staring at 42 denials right now for this exact reason.