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amyrose

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Long story short...My office merged with a local hospital network and they are on the Epic System. In our old system when coding for medicare patient who gets an bilateral injection of synvisc one per medicare guidelines we are to bill 20610 50 and j7325 rt and j7325 lt. However now we are being told by the central billing office of the network we joined that CCI edits want it to be 20610 rt 20610 lt j7325 rt j7325 lt

example 2 was injections to 2 different sites we would code 20610 rt with correct DX code and the second would be 20610 59, rt with the correct dx code. they are trying to tell me that i have to explain in an attached note to each 20610 code which body part?? Doesnt the dx code explain the body part..at least that is what i thought!

Please help..:confused: :confused:
 
This is an e-mail that I got from my supervisor September 2010 about this.

3M states that these codes should no longer have the LT and RT modifiers applied to them as they could be an injection/aspiration of a joint or bursa that is not a paired organ. Please discontinue using the modifiers on these codes.

Thanks!!!
 
wow I did not know that. We use quantim and it always flags these codes as needing lt,rt, or 50 modifier. Is that an error then?
 
amyrose said:
Long story short...My office merged with a local hospital network and they are on the Epic System. In our old system when coding for medicare patient who gets an bilateral injection of synvisc one per medicare guidelines we are to bill 20610 50 and j7325 rt and j7325 lt. However now we are being told by the central billing office of the network we joined that CCI edits want it to be 20610 rt 20610 lt j7325 rt j7325 lt

example 2 was injections to 2 different sites we would code 20610 rt with correct DX code and the second would be 20610 59, rt with the correct dx code. they are trying to tell me that i have to explain in an attached note to each 20610 code which body part?? Doesnt the dx code explain the body part..at least that is what i thought!

Please help..:confused: :confused:
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hey amyrose

for your first example your old metod is more appropriate, cause i also use to code the same... 50 modifier is for bilateral procedures... so we can append .... but the other sets of codes are also right but.. why to code like that if we have more sophisticated way of doing it.

same about example 2 ....

As per my experience in coding ... their are many ways of coding certain things .. it only depends on the way of perception of coders and how situations are considered.


hope it helps :)

Sumeet
 
first 3M does not dictate rules for coding. joints do have laterality, and bursa are located around the major joints and therefore are considered bilateral. I would love to see the communication from 3M that indicates the use of 50 and RT and LT is unacceptable for the 20610. The ICD-10 CM codes are laterality specific in this area and you will want to pair this with a modifier for the procedure to avoid unnecessary denial of the claim. I am not sure what Epics issue is with regard to these modifiers, but Medicare my have an issue with you using RT and LT for bilateral, also it will be hard to link a bilateral dx code to an RT and LT modifier instead of a 50 modifier. I would definitely ask for clarification and point out the ICD-10 CM issues with the codes.
 
We use Epic and we are able to use modifier 50.

I know that some payers want the use of RT and LT but that is payer specific and you would have to inquire of each payer as to how they want it coded.
 
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