Wiki Medicare denying 36471-RT and 36471-LT


Port Charlotte, FL
Best answers
Medicare is denying 36471-RT and 36471-LT on the same day as CO151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.

Our doctor did sclero on multiple veins, same leg on both legs on the same day. The rep at FCSO Medicare is saying only one unit per day for 36471 and suggested to resubmit the claim with appropriate modifier. But I am using the RT and LT. Didn't think I should use 50 modifier because it isn't exactly the same on both sides. Do I need a 59? Any suggestions?

Thank you,
On only one 36471? Or both?

FCSO says Bilateral surgery and it's a 1

150 percent payment adjustment for bilateral procedures applies. If 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), contractors base payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides or (b) 150 percent of the fee schedule for a single code. If 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 applicable multiple procedure rules.

Am I missing something or not understanding something?

Thanks again!