Wiki Chromotubation (58350) and laterality

[mkunzer]

Trying to obtain a clearer understanding of why payers want laterality modifier when it comes to billing Chromotubation (58350). Dye is injected and travels to both tubes so essentially we are reviewing bilaterally. If dye spills, test is good in showing patency. If no spill, test is good in showing blockage. So, essentially, isn't this always a bilateral procedure?

 

[karitoon]

There are times when it would be a unilateral procedure if the patient only has one fallopian tube.

 

[csperoni]

There are definitely scenarios where it is performed unilaterally, such as the example provided where patient only has one fallopian tube.
Here's the more in depth answer. Each CPT code has a value assigned, and part of the value determination is based on whether it is inherently bilateral and/or described as unilateral or bilateral. CMS assigns an indicator as to whether or not modifier -50 is applicable. So, when the code was first created over 35 years ago, those involved decided to describe it as "oviduct" vs "oviduct(s)" and value it for unilateral. CMS then assigned that bilateral indicator 1 meaning when performed bilateral, the -50 modifier will result in payment of 150% of the fee schedule.