Bilateral procedures - Am new to ENT coding

crystalm

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Am new to ENT coding and have a question regarding billing bilateral procedures. Everyone I have talked to gives different answers, so am not sure what to go with. Would you bill say a 69436 tympanostomy as one line item with the -50 and the price at 150%; or do we bill it as two line items with the -50 on the second code. Also, if we bill it as two line items, would we charge full price for the second code and let the insurance comp reduce it on their own? I'm really confused with all of this for now! Any help would be appreciated. :confused:
 

jmgrier

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Local Chapter Officer
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Chesapeake
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Good Morning :) I would bill two lines with the same amt for each line. The insurance company will take the proper adjustments.

69436 RT
69436 LT 59

I hope this helps :D
 

AndieL

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Greenfield Township, PA
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Hello,
First rule of thumb is never reduce your charge-leave that up to the insurance company-if you reduce your charge you may not get the full amount that is owed to the physician.
Second, my advice would be to check with the insurance companies to see how they prefer the bilateral codes to be submitted to them. I would start with your biggest payors first. We have to send our bilat's one way to our Medicare Carrier(one line item with the 50 modifier x 1 unit and we double our charge)and a completely different way to one of the local HMO's (one line item without any modifer-second line item with a 76 modifier).....so it all depends.
AndieL
 

eroland

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Akron
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Hello,
I agree with AndieL. Never reduced your charge (let the insurance companies do that) I work in an ENT group and we have to bill our bilateral procedures differently depending on the insurance carrier. I would also suggest contacting your carriers and finding out exactly how they would like bilateral procedures billed. You might find that info on each carriers website, too.
Billing bilateral procedures incorrectly could result in lower reimbursement or denial for duplicate line times, which will take you even more time to correct and resubmit- delaying payment even more. I hope this helps.
 

sbenden719

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Maryland
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different insurance have different rules, Aetna requires us to bill seperatly...69436 on one line and 69436-50 on the second line..full amount on first line and 1/2 rate on the second, if this makes sence...no need for LT and RT...but this is our rule and how we do it...check with insurance
most times its...69436-50 on one line with full amount...just my input:)
 

dixiesheppick

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West Jordan, UT
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Bilateral and multiple procedures

I have a question- We have been having trouble with one of our insurances paying for the full sinus surgery. When we submit we use the following, do you bill it out this way also? The other question is would you bill the highest bilateral procedure 1st?

example:
30520
31276-51
30140-50-51
31255-50-51
31267-50-51
31287-50-51
61795

I would appreciate any advice anyone could give me on this. Thanks
 
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