93971

JJOHN0312

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Since 93971 has limited or unilateral in the descriptor, should we report that with LT or RT modifier. I have found MLN Matters 6526 that states 93971 is not a bilateral procedure and this would not be reported with 50 or RT/LT modifier??

Any thoughts?

Thanks

Josie
 

CodingKing

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93970 would be your bilateral code. We do not put RT/LT on our codes because the dx code should tell you if it is RT/LT


Guidance that was issued is you still need to use the proper RT LT modifier if it applies. Use of these modifiers did not go away with the introduction of laterality in ICD-10. This was one of the top misconceptions about ICD-10 conversion and multiple notices were sent out about this.


https://www.optum360coding.com/CodingCentralArticles/?id=1581
 
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JJOHN0312

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I think the issue is not the diagnosis but rather the CPT that we should not be appending RT, LT, or 50. If the CPT already states unilateral or bilateral, modifiers (payment policy indicators) should not be applied. That is what I am understanding with the MLN Matters that I previously posted. However, if you have something from Medicare that states otherwise, please post.

Thank you!

Josie
 
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I agree with 93970.

Here's the CMS fee schedule:
93971.jpg

93971 has a bilateral indicator of 0 which means "150% pymt adjustment for bilateral procedures does not apply. The bilateral adjustment is inappropriate for these codes because of physiology or anatomy or because the code description specifically states the procedure is unilateral and there is an existing code for a bilateral procedure."
 
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