Another Modifier 50 Question!

lisamgoguen

Networker
Messages
40
Location
Husdon, New Hampshire
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OK, So I have been reading through some of the modifier 50 threads, and while they somewhat answer my question, they don't quite do it.

Scenario:
Biller posted charges for unlisted foot surgery (28899 x1) and then again for the what should have been for the assistant surgeon (28899.50 x1).

I know that this is all wrong! It should really be (28899.50) and then (28899.50.80).

My question is this.... should it be billed at 1 unit each or 2 units each? Because it is an unlisted code, I can't seem to find a bilateral indicator.

Help!! Lisa
 

CBaer

Networker
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70
Location
Dillsburg, PA
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Billing Mod 50

It really depends on the carrier.

You really should check with your particular carriers, with that said if it is Medicare you would always bill with one unit and ensure the fee is doubled.

Cheryl
 

lisamgoguen

Networker
Messages
40
Location
Husdon, New Hampshire
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Thanks! I knew about Medicare, but the commercial carriers make it difficult.

I am working with Harvard Pilgrim here in New England. I will have to reach out to a provider rep because everytime I try to discuss something like this with a rep, they say, "We can't tell you how to bill."

Again... thanks so much!

Lisa
 
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