ASC modifiers - I am familiar with the modifiers

susanlwright

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I am familiar with the modifiers approved for use in an ASC. I am not so sure, however, how the Level II National Modifiers are applied, ie., fingers, toes eyelids, etc. If you had three hammer toes, would you put the CPT on 3 separate lines with the appropriate T modifier or would you put the CPT on 1 line with all the modifiers and quantity of 3?

According to Trailblazers (our Medicare carrier - Colorado) instructions on ASC coding, they do not like the 50 modifier. They prefer the CPT be billed out on two separate lines with RT and LT. Do you charge the same fee for each line or do you reduce the 2nd line?

How about other payers? How do you bill bilateral modifiers? Do you use -50 and increase the fee?

I would appreciate any ASC coders responding.

Susan L. Wright, CPC
 

mbort

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I seperate them out by line item for every carrier both Medicare and commercial.

example:
28285-TA
28285-59-T1
28285-59-T2

You charge the same amount for each procedure with no reduction, the carrier whether its Medicare or commercial will discount the line item according to their specific payor contracts/rules.


Hope this helps. I responded to your private message and gave you my contact info :)
Mary
 

tennislaurie

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Instead of the modifier 59, you would use the modifier 51 for multiple procedure since the toe modifiers are indicating a different toe.
 

smcbroom

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I would do coding the same as MBort and agree with the answer she has given for ASC's
 
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