Cpt 70110

[fisherdawnmarie]

I have report that reads bilateral mandible 4 views. Doesn't CPT 70110 include both right and left?

Thank you.

 

[dmaec]

no, it simply means four or more projections are taken for a complete view of the bone structure. (as opposed to three or less) I'd use RT/LT on the 70110 (not .50)
70110.RT
70110.LT
that's my three pennies (inflation yaknow)
Donna

 

[llewis]

I have report that reads bilateral mandible 4 views. Doesn't CPT 70110 include both right and left?

Thank you.

yes, because it says complete.

llewis

 

[dmaec]

yes, because it says complete.

llewis

complete does not mean bilateral. If the code was bilateral, it would state so in the discription like the code 77059 states "bilateral". another example, look at codes 73500 radiologic examination, hip, unilateral;one view - 73510 complete, minimum of two views (the complete does NOT mean bilateral!)THEN 73520, radiologic examination, hips, bilateral, minimum of two views of each hip, including anteroposterior view of pelvis.
see the difference in bilateral codes? it states bilateral -

 

[jhayes]

Donna is correct!

 

[kimb]

x-rays

why would you apply modifier 59 to x-rays of both knees instead of Lt & Rt. I
always put the Lt & Rt if both knees are done, but one of my co-workers said
it needs to be modifier 59. Help with the confussion

thanks

 

[dmaec]

which codes are you using?

 

[kimb]

donna

we used code 73562 radiologice exam, knee three views both knees

thanks for your help

 

[dmaec]

I agree with you kimb - on that code 73562 each side, I'd use the LT/RT.

They're not coding other codes with it are they? For example; "If" (and I hate "ifs" and "buts"), but - "if" they're also doing the 73565 along with the 73562 codes - then the 73562's will need the .59.LT/.59.RT mods on it.

 

[mbort]

my experience has been that if you are using the same code twice (even x-rays) the carrier will more often than not, deny for duplicate. It is in your best interest to avoid denials by putting the modifier on the 2nd line item.

73562-rt
73562-59-lt

Just my two cents
Mary

 

[mbort]

Now for my reply on the 70110- The lay description states:

The lower jaw bone is x-rayed. In 70100, three or less projections are taken for a partial view of the bone structure and in 70110, four or more projections are taken for a complete view of the bone structure.

I looked on Encoder Pro, which generally has 50 modifier next to the code if the 50 modifier is acceptable, and it is NOT present. Therefore I agree with llewis and fisherd, I believe that this is a "complete" x-ray. (the mandible is not considered two structures like the hips, arms, legs, ears, etc--its only one)

 

[dmaec]

I was going ask if your co-workers ever followed the claim to see how it's being paid - it could be a carrier preference. I know where I work, the RT/LT is what differentiates the area to the insurance and it gets it paid, some (medicare) even prefer the .50 for bilateral. But, you shouldn't need a .59 modifier on the code if the only codes they're billing are 73562.RT & 73562.RT.

mbort - I get what you're saying but it really shouldn't be denied using just the RT/LT.

 

[mbort]

To back up my previous reply on the 70110- I also just checked the crosscoder for modifiers- Neither the RT/LT nor the 50 modifier is appropriate for that code.

 

[dmaec]

nice catch mbort YOU are right! (I was wrong) I double checked the RVU schedule and in the bilateral column it has a "0" indicator - (not a 3). Bilateral does not apply to this code!

fisherd - SORRY! I was mistaken! I thought I had doubled checked the RVU's schedule before I answered your question - apparently I read it wrong In any case, mbort is correct - 70110 means complete - however, it does not mean bilateral - (that's why we can't use the LT/RT or 50 on it) It's just complete, no mods needed

jhayes - I was wrong sorry about that.....

llewis - YOU were right all along!

sorry guys, I have to double check my double checks in the future !