alyssa1990
New
Ex:
When a provider orders a bilateral xray of the knees AND 3 additional views of the right knee, per CCI guidelines we are not allowed to bill the bilateral xray with a unilateral xray code.
What we have been doing is removing the charge for the bilateral xray (CPT 73565) and instead using the CPT codes for 1-2 view of the LT knee (73560) and 4+ views of the RT knee (73564), with an XU or XS modifier. Is this the correct way to bill it?
Otherwise we were thinking we could remove the charge for the unilateral xray(s) and ONLY bill the bilateral xray code. If we did it that way, we would have different charges built into our chargemaster for the same bilateral knee CPT code (73565), that way a total of 2 views would be cheaper than a total of 5 views...if that makes sense. For example, there would be different labels (1-2 views, 3 views, 4+ views) that would all be attached to the bilateral CPT code 73565, but they would all have different dollar amounts associated with the number of total views of both knees combined. I did bring up the question if the insurance companies would have their agreed upon dollar amount for the bilateral CPT so it wouldn't matter if we changed the price or not, but they did not think that would be an issue. Does anyone bill it this way?
Someone also asked about if there was any correct way to bill it with modifier 50, but I don't believe there is. Any advice on this situation is greatly appreciated!
Thanks
When a provider orders a bilateral xray of the knees AND 3 additional views of the right knee, per CCI guidelines we are not allowed to bill the bilateral xray with a unilateral xray code.
What we have been doing is removing the charge for the bilateral xray (CPT 73565) and instead using the CPT codes for 1-2 view of the LT knee (73560) and 4+ views of the RT knee (73564), with an XU or XS modifier. Is this the correct way to bill it?
Otherwise we were thinking we could remove the charge for the unilateral xray(s) and ONLY bill the bilateral xray code. If we did it that way, we would have different charges built into our chargemaster for the same bilateral knee CPT code (73565), that way a total of 2 views would be cheaper than a total of 5 views...if that makes sense. For example, there would be different labels (1-2 views, 3 views, 4+ views) that would all be attached to the bilateral CPT code 73565, but they would all have different dollar amounts associated with the number of total views of both knees combined. I did bring up the question if the insurance companies would have their agreed upon dollar amount for the bilateral CPT so it wouldn't matter if we changed the price or not, but they did not think that would be an issue. Does anyone bill it this way?
Someone also asked about if there was any correct way to bill it with modifier 50, but I don't believe there is. Any advice on this situation is greatly appreciated!
Thanks