Wiki Bilateral radiology modifiers

[jdibble]

Which is the correct way to bill a bilateral radiology procedure (one that is not stated as bilateral, or does not have a bilateral code). For example, 73020 Radiologic examination, shoulder, 1 view. Would you code 73020-50 or 73020-LT and 73020-RT. The information in the Medicare IOM is confusing as which codes to use and we are trying to update our chargemaster with the correct coding.

Thanks!

 

[BenCrocker]

If the code said Shoulders it would be bilateral. As it doesn't and just says Shoulder I'd say it's already unilateral. And I think you use modifier 50 over LT or RT when modifier 50 apples.

 

[OCD_coder]

For Medicare MACS: The use of the modifier 50 for bilateral radiology procedures (when the code description states unilateral) does not apply to when they have a status indicator of "3". When you have MUE edits of 1 or 2, you would bill with the laterality modifiers only (eg, LT, RT).

Physician Fee Schedule Tool Lookup:
http://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=1&HT=0&H1=73020&M=5

Status Indicator Definitions:
https://www.noridianmedicare.com/je/partb/docs/2013_mpfs_indicator_descriptors.pdf

 

[jdibble]

For Medicare MACS: The use of the modifier 50 for bilateral radiology procedures (when the code description states unilateral) does not apply to when they have a status indicator of "3". When you have MUE edits of 1 or 2, you would bill with the laterality modifiers only (eg, LT, RT).

Physician Fee Schedule Tool Lookup:
http://www.cms.gov/apps/physician-fee-schedule/search/search-results.aspx?Y=0&T=1&HT=0&H1=73020&M=5

Status Indicator Definitions:
https://www.noridianmedicare.com/je/partb/docs/2013_mpfs_indicator_descriptors.pdf

Thanks OCD! That was very helpful!

 

[sopka9476]

We code w/ mod-RT, LT