Wiki Billing Synvisc J7325 with RT LT modifiers

[BradSW]

This is a new issue for me so I'm hoping someone is more experienced with this. I've never considered using modifiers RT/LT or modifier -50 as being appropriate for a drug code. However, I'm now being told by Regence BCBS of Oregon (thus far specifically the Innova claims) that their claims system is set up to only pay for bilateral injections by doing so. I caught this issue by reviewing payments received for 2012 Synvisc One bilateral injections. I found that they were only paying for single doses even though the correct units were billed. Other insurance companies are paying without issue the expected amount without the modifiers, but I'm wondering now if I'm going to have to start using RT/LT on all our claims. Anyone know about this??

 

[rlreynolds]

J7325 with RT LT modifiers

Hi, I am from Florida

Our BCBS also gives us a hard time. if I am billing for example 20610 I only use one modifier on 20610. If I am billing both RT and LT I put modifiers on both J code and CPT. I have not used the 50 modifier.

Do you use guided ultrasound for injections?

 

[ollielooya]

We've been advised to use the RT and LT modifiers along with the units when billing for this drug. Other than the fact that sometimes the payers will inadvertently only pay for one line a simple phone call usually clears up the problem. We have not had any major issues/headaches billing it out this way on two separate lines for the past year.

 

[airart]

RT LT 50 Modifiers and Synvisc Injections

I found the below from a previous topic on this on the AAPC forum too. Good info. Thought I would share. Second piece is from an article I found online. Hope it helps.

AAPC Forum, July 19, 2010:
Initial Topic Question:
We recently billed the below and the carrier only paid for the 20610 codes. The carrier denial says invalid modifier. I think that the RT and LT should not be used for a J-code, but I don't know how to properly bill this Synvisc.
20610-RT
20610-LT
J7325-RT 48 units
J7325-LT 48 units
J1020-59
J1020-59

Responses:
A: I don't submit with RT/LT modifiers with J codes. You also would not need the modifier 59 on your J codes, just bill the units on the medications. All our considered CPT modifiers and only should be reported with CPT procedure codes. Here are examples of how are practice bills Synvisc.

For Medicare, Blue's, UHC we bill bilateral Synvisc injections:
20610-50 x1(unit) at 150% of the fee
J7325 x96 (units)

All other payers:
20610
20610-50
J7325 x96

No problems whatsoever even billing for all three different visits.

Another article found:

The new HCPC code, J7325, is reported for both Synvisc and Synvisc One, the injection code is easy, and so we will start there— Bill using CPT 20610. The reporting of Synvisc is dependent on what drug you are using. Synvisc One: is a concentrated dose, is only administered one time and is reported with 48 units. (J7325 x 48) Synvisc: same drug, but is less concentrated and administered over three different visits. So at each visit, you will report 20610, J7325 x 16 units. Report this for the first, second, and third injections.

Hope this helps answer your question and reimbursement dilemma. If you forget the units, Medicare will only reimburse you for one unit!
(Source: www.karenzupko.com)