Wiki cpt codes 27216 & 27217

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pwebbabshire@cox.net

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So, cpt code 27216 is getting denied for medicaid and a few other insurances when I code this twice for LT & RT. We only use the G code for Medicare or Medicare supplements. I have been told by one coder that 27216 and 27217 can only be used once regardless of Lt & RT being fixed. Then another coder says to code this twice and put the laterality on both codes. The medicaid we work with will not take modifier 50, has to be LT & RT. Would anyone have any suggestions going forward on how to code this if the Dr. fixed Lt & RT. Maybe we should treat this as a whole unit as 1.
Thanks,
 
Under 27216 and 27217 there are a parentheticals stating to report bilateral procedure with modifier 50.

For the Medicaid case, I would appeal with notes if they don't accept modifier 50.
 
The particular Medicaid plan, or other insurance you are billing to, should have a modifier 50 or bilateral surgery policy which would instruct you on how they expect it to be billed. If you have coded two lines, each one unit, one RT, one LT and they denied it, obv. that's not how they want it. They definitely don't want the G code? Some MCD want the G code too.
Most want to see one line, one unit, modifier 50, double the billed amount.
Others want to see one line, two units, RT/LT on same line, double the price.
Some want two lines, one unit each, modifier 50 on line two.

I would start by looking up the payer's specific policy on either bilateral surgery or the specific code and see if they want the G code instead.
 
They have said no modifier 50 and they will not take the G code. From what I found out it seems as though we can just code this once with no modifier if it was performed on both sides. My other payors I can put a 50 modifier on these codes.
Thanks,
 
pwebbabshire@cox.net said:
They have said no modifier 50 and they will not take the G code. From what I found out it seems as though we can just code this once with no modifier if it was performed on both sides. My other payors I can put a 50 modifier on these codes.
Thanks,
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They may be like Medicare and consider it a uni or bilateral code and have an MUE of 1 even though the description says uni.
For the particular plan you are getting a denial from, how was it coded to them? When you say, "code this twice for LT & RT" what do you mean? Did you do two lines, one unit, one RT, one LT? Or did you do one line 2 units?
 
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