Wiki LT and RT with C1762 and C1763

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Deleted member 616635

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Hello,
I bill for an ASC and we have been getting denials for laterality modifiers on C1762 and C1763 for some reason. These codes are for wrists and shoulders mainly. From the HCPCS book it states, "Modifiers LT and RT identify procedures which can be performed on paired organs. Used for procedures performed on one side only. Should also be used when the procedures are similar but not identical and are performed on paired body parts." It's almost inferred that the implant is not a procedure and therefore doesn't need a laterality modifier. Does anyone have advice?
 
Maybe the particular payer has some requirement that they want it. If you are getting denials...Wouldn't it make sense to indicate which side the connective tissue was used for, maybe? Did you check the payer policy? Sometimes payer policies and payment guidelines don't always align with CPT or CMS.

Has a report been run to determine the number of claims impacted, which payer(s), and what type surgeries, etc.? If that is done it may shed light on if it is one single payer issue.
 
Deleted member 616635 said:
Hello,
I bill for an ASC and we have been getting denials for laterality modifiers on C1762 and C1763 for some reason. These codes are for wrists and shoulders mainly. From the HCPCS book it states, "Modifiers LT and RT identify procedures which can be performed on paired organs. Used for procedures performed on one side only. Should also be used when the procedures are similar but not identical and are performed on paired body parts." It's almost inferred that the implant is not a procedure and therefore doesn't need a laterality modifier. Does anyone have advice?
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Are you getting denials because you added a laterality modifier, or because you didn't add one? Unless the payer specifically wants it, I wouldn't add it. I'd consider it a supply code, and since it can be used universally (not a specific version of the product was made for just the left or the right, like an orthotic would be) I wouldn't add the laterality modifier.
 
iowagirl77 said:
Are you getting denials because you added a laterality modifier, or because you didn't add one? Unless the payer specifically wants it, I wouldn't add it. I'd consider it a supply code, and since it can be used universally (not a specific version of the product was made for just the left or the right, like an orthotic would be) I wouldn't add the laterality modifier.
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Oh yeah, good point lol. I read it that they were getting denials for NOT having it. If you are adding it to those and it's denied then take it off for sure lol
 
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