How to use a 50 modifier?

chembree

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I am reviewing some of our old claims. When we perform procedures such as facet joint injections we bill 64493 (50) x 1 unit if the procedure is bilateral. The problem I am noticing is we are getting paid from all of our insurance companies as if we only performed 1 procedure. There is no extra payment for doing both sides. We have received denials from Medicare in the past for billing multiple units. So my question is… how does your practice use a 50 modifier?

We are considering billing 64493, 64493-50…. But I don't want to create denials for duplicates. Any ideas?
 

armen

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Atlanta
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I am reviewing some of our old claims. When we perform procedures such as facet joint injections we bill 64493 (50) x 1 unit if the procedure is bilateral. The problem I am noticing is we are getting paid from all of our insurance companies as if we only performed 1 procedure. There is no extra payment for doing both sides. We have received denials from Medicare in the past for billing multiple units. So my question is… how does your practice use a 50 modifier?

We are considering billing 64493, 64493-50…. But I don't want to create denials for duplicates. Any ideas?
Different payers may have different rules for reporting bilateral procedures. Some will want you to use modif 50 with 2 units, some with one. What I would do is : 64493+64493-59 or try 64493x2units. This code has a billateral indicator of 1, which means:
1=150% payment adjustment for bilateral procedures applies. If the code is billed with the bilateral modifier or is reported twice on the same day by any other means (e.g., with RT and LT modifiers, or with a 2 in the units field), base the payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150% of the fee schedule amount for a single code. If the code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any multiple procedure rules.
 

Evelyn Kim

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I would agree, if you are billing with a 50 modifier then the payment should be 150 % of the base unit. In Texas Medicare prefers the 59 or the rt/lt over the 50, but each payer is different and each will have their own preference.

I would not bill 64493, 64493-50 as this would be creating a confusing claim for the payer.
 

armen

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I would agree, if you are billing with a 50 modifier then the payment should be 150 % of the base unit. In Texas Medicare prefers the 59 or the rt/lt over the 50, but each payer is different and each will have their own preference.

I would not bill 64493, 64493-50 as this would be creating a confusing claim for the payer.
totally agree with this. it looks like 3 units actually, since modif 50 is already 2 units basically and then you have another unit without modifier. Its the same as to say Rt foot + Lt foot + just foot :)
 
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