Wiki Bilateral procedures - I am having a problem

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miller_ide

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I am having a problem getting paid for bilateral FNA's I've tried coding on the same line using 2 units and a 50 modifier. I've also tried coding on two separate lines with a 50 modifier on only one line. MCA will only pay for one.....:confused:
 
bilateral fna

Is the FNA of the same lesion or "surgical field"? If it is, it can only be coded once. If it is separate, try modifer 59, since it is a separate and distinct procedure.
 
It would be a right side thyroid biopsy and left side thryoid biopsy completely separate nodules..
 
According to the CMS Physician Fee Schedule, an FNA is not a bilateral procedure. The code is for a biopsy and doesn't specify any body part that is bilateral (such as arms or legs) so, even though modules on each side of the thyroid are being biopsied, LT and RT modifiers or the 50 modifier would not be appropriate. If you want to submit the FNA code more than once, I would agree with the 76 and 59 to show you repeated the procedure (76) and that it was done in a totally different area (59).
 
I agree with the use of the 59 this is appropriate as the procedure is not designated as a bilateral type procedure. However the use of 76 modifier is not appropriate. This is used for a repeated procedure, when you do a separate FNA on a different area then the procedure is not repeated it becomes a new distinct procedure. A repeated procedure would be for example a post reduction x-ray to check to see if correct alignment has been achieved.
Debra Mitchell, MSPH, CPC-H
 
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