Wiki Different Modifiers for Billing and Coding?

[ann0327]

Hi,

Can someone with experience please explain if there are different modifiers for billing and coding? If so, please give a scenario. Thank you.

 

[hbair99]

In my experience for example with bilateral modifier 50. Medicare on the facility side wanted it billed as one unit with modifier 50, however some insurance companies like it split into two lines, same cpt code with RT and LT attached. For example xray both shoulders 73030. Medicare may want it 73030-50 x1, and another ins co will want it 73030-RT x1 and 73030-LT x1. A coder would probably just set it up as one unit with 50 modifier. Hence why coders and billers should work together. Hope this helps!

 

[ann0327]

In my experience for example with bilateral modifier 50. Medicare on the facility side wanted it billed as one unit with modifier 50, however some insurance companies like it split into two lines, same cpt code with RT and LT attached. For example xray both shoulders 73030. Medicare may want it 73030-50 x1, and another ins co will want it 73030-RT x1 and 73030-LT x1. A coder would probably just set it up as one unit with 50 modifier. Hence why coders and billers should work together. Hope this helps!

Thank you for your quick reply and it did help. Coders and billers are in separate areas at my job.