Wiki Bilateral coding

[Pam Blackford]

CPT code 64520. Looking at the code on the Medicare fee schedule, it has Bilateral as a 1. Looking at the status indicators explanation sheet, it indicates that the bilateral rule does apply. does this mean that we must always use either the 50 or LT/RT for a single side? Our providers say this code is being done in the middle and won't state anything about it otherwise in their note. I just want to be sure that we MUST use the modifiers. We do have payers that deny for no modifier being used. Thanks!

 

[TThivierge]

Hi Pam,
CPT 64520 lumbar or thoracic are differ places on body. If in provider s documentation states both sides or left or right use the proper modifier. However lumbar is in middle of back of body and thoriac is area in back under neck area thus I can see why not want to use a modifier. But if both back areas receive pain injections, then I 'd use modifier 51 on 2nd treated area on claim
I hope this data helps you
Lady T.