Wiki bilateral procedures - charge double?

[rkindlund]

I have been told by other coders to double the fee on any procedure code that I bill with a modifier 50. However, if I know the payer's fee schedule and that they will pay 150% on a bilateral, which is still lower than my billed fee, why would I want to double it? It seems the only purpose this serves is to dramatically increase the amount I am adjusting off.

e.g.

fee for code is $1425 and BCBS allowable is $730.99. At 150% they should reimburse roughly $1097. If I bill $2850 for a bilateral, I'm writing off way more.

Clarification? Advice?

 

[lorrpb]

If you bill $1425 they could interpret that as the amount for 2 units, which would make one unit equal to $712.50. So they could pay at 150% of $712.50 for bilateral, because your fee now is seen as lower than their fee schedule amount of $730. Thus, they could allow $712.50 x 150% = $1068.75 and pay their % of that.

 

[rkindlund]

Thank you so much; this makes sense.