Wiki BILATERAL X-RAY

[raenayg]

AZ Complete Health (Medicaid) recouped multiple claims we have billed as follows:

99203 (M17.12) - PAID
73562-LT (M25.562) - RECOUPED/DENIED
73562-RT(M25.561) - RECOUPED/DENIED

We also have other claims that we billed different x-ray codes for bilateral areas with -LT and -RT that have recently recouped and denied. When we contacted AZ CCP for clarification we were advised to contact PaySpan due to denial indicates overpayment however the recoupment leaves a zero payment. Is this a coding issue with the -LT and -RT modifiers? I am wondering if we should be applying -50 modifier instead. Any advise will be appreciated. Thank you.

 

[trarut]

This is really a payer-specific answer. Have you checked the payer portal for a bilateral services reimbursement policy? I had to summarize bilateral services for my coders a few years ago and we had about 14 different payer policies impacting how those services were coded. Some plans want one line with a -50 modifier x 1 unit, some want it as you listed it above, there was one plan who wanted two lines with a -50 modifier on the second line. I would definitely contact PaySpan as you were advised and ask them for policy information to back up the denials/recoupments.

I hope you get lucky and someone who has worked with AZ Medicaid will be able to chime in.

 

[Orthocoderpgu]

That's all I can think of. Some payers want -RT & -LT, others want -50. So frustrating.

 

[trarut]

That's all I can think of. Some payers want -RT & -LT, others want -50. So frustrating.

Right? We actually had one payer - oh, I can't remember who - who wanted the charge on two lines with a -50 modifier on the second line. You may as well just make things up at that point LOL