Wiki Bilateral HELP PLEASE

[ccillo]

Hello:
What is the proper rule for all payers for bilateral procedures?

Claim Line 1 - CPT code - 50 @ 1 unit OR

Claim Line 1 - CPT code - 50 @ 2 units OR

Claim Line 1 - CPT code - @ 1 unit and
Claim Line 2 - CPT code (again) - 50 (1 unit)

Any assistance would be greatly appreciated.

Thank you,
Cindy S. Cillo, CPC

 

[mbort]

good luck with this one. All payors have their own guidelines for bilateral. It wouldbe so much easier if they were all on the same page, but thats how they get away with what they do. They all have a different set of rules.

 

[Lisa Bledsoe]

For one, it will depend on what CPT codes you are using. Radiology is different from "procedures". Here's what we do for bilateral joint injections without much trouble from the payers:
Medicare and BCBS:
20610 -50 x1 unit at 150% of the fee
All others (for now):
20610 -rt xt 1 at full fee
20610 -50-lt x1 at 50%
You don't need rt/lt, but I have found it helps.
Lisa