Wiki How best to report bilateral 20610 to Medicare

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krburke

krburke

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One of my providers has given 20610 injections in both knees. How does Medicare want to receive these codes? These are the options I came up with:

20610-RT x 1 unit
20610-LT x 1 unit

OR
20610-50 x _ units? Would this be billed as 1 or 2 units? Any other modifier besides -50?

I have not had to bill this procedure as bilateral before, whenever he has given more than one injection, there were two different joints with different codes (e.g. knee and elbow). I am rusty on appropriate use of modifier 50 since I rarely have to use it. Thanks.
 
I assume you are billing the professional fee (as opposed to a facility charge). If that is indeed the case, then you would bill like this:

20610-50 x 1 unit

Don't forget to bill the J code as well.
 
kburke@hcbr.biz said:
One of my providers has given 20610 injections in both knees. How does Medicare want to receive these codes? These are the options I came up with:

20610-RT x 1 unit
20610-LT x 1 unit

OR
20610-50 x _ units? Would this be billed as 1 or 2 units? Any other modifier besides -50?

I have not had to bill this procedure as bilateral before, whenever he has given more than one injection, there were two different joints with different codes (e.g. knee and elbow). I am rusty on appropriate use of modifier 50 since I rarely have to use it. Thanks.
Click to expand...
Hello,

You do not want to use the 50 modifier with Medicare, there is some coding issues with the 50 . Medicare does not want 50 modifier. The way you had is the way you need to do it.
Beware using 50 modifier with Medicare.
 
nathalie1@cfl.rr.com said:
Hello,

You do not want to use the 50 modifier with Medicare, there is some coding issues with the 50 . Medicare does not want 50 modifier. The way you had is the way you need to do it.
Beware using 50 modifier with Medicare.
Click to expand...

I don't know where you get your information, but we bill 20610-50 to Medicare every single day, and have no problems at all.
 
I agree with Walker. In fact Medicare states that bilateral is a one line charge with the 50 modifier. There was a Medicare memo that came out regarding this in 2002.
 
mitchellde said:
I agree with Walker. In fact Medicare states that bilateral is a one line charge with the 50 modifier. There was a Medicare memo that came out regarding this in 2002.
Click to expand...
Thanks Debra and Walker for your responses.

I am curious about how Medicare reimburses when the -50 modifier is used. The provider has essentially performed the same procedure two times. Is the Medicare allowed amount higher when the procedure has a -50 modifier than when it is filed without the modifier as a single procedure?

Thanks,
Kathy
 
When a code is billed with a mod-50, the allowed amount is paid at 150% of the allowed amount. The code has to be eligible to be billed bilaterally (see RBRVS appendix) in order for this to be true, however. Not all codes are bilat eligible.
 
20610

Does anyone have any updates on this problem:

I have billed as:

1) 20610-50 x 1 unit
20610 x 1 unit

2) 20610-50 x 2 units

3) 20610-50 x 1 unit (with the price of 2 showing on claim)

All have been denied recently, I have a valid diagnosis so I know that is not the problem.

Thanks
 
20610

The first 2 say are denial code M86 - Service denied because payment already made for same/similar procedure within set time frame.

3rd denial states ti submit as a new claim electronically not as an appeal then when that was done it was denied as a duplicate.

What is the correct way of billing two 20610 in one visit with a valid diagnosis code?

Thank you for your help.
 
when billing Medicare as well as most other payers it is
20610 50 with 1 unit of service and the single code charge.
that is if the procedure was performed bilateral, If the procedure was performed say on the right shoulder and right hip then it would be
20610 rt
20610 59 rt
if it was performed on the right hip and the left shoulder it would be
20610 rt link to dx 1
20610 lt link to dx 2
the denial suggests that there is a prior encounter for an injection of the same area within too close a timeframe to the current billed encounter. Is this possible?
 
Medicare's CCI edits indicate that we can bill 20610 with a -50 modifier. We bill on one line with 20610-50 with one unit and the price 1.5x. Seems to be working for us.
 
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