Wiki mod 50 for facet injections in asc

[dbrewer]

Certain workers comp insurance companies are denying payment for facet injections stating modifier 50 needs to be added. Is anyone having similar problems? For example, bill 64490 with one or two units and 50 modifier?

 

[nbluvette]

This is the Medicare guidance on this.....you might follow this and send in this guidance for consideration of appropriate coding.

http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM6518.pdf

 

[gurtmurt79]

Trying using LT & RT modifier to show bilateral. I bill for a pain management ASC & never use the -50. 64490LT & 64490RT Its worth a try. I have never had a denial billing this way.

 

[rkmcoder]

For ASC coding (and probably other sites-of-service), bilateral billing is carrier specific. Some carriers want to see modifier -50. Some want to see -LT/-RT. Some want to see -LT on the first line and -50-RT on the second line. Some want to see x2 units. Workers Comp and No-Fault are jurisdiction specific, so contact your state agencies. Or file the claims and await the outcomes, then keep good records so you don't make the same errors over and over.

Richard Mann, your pain management coder
rkmcoder@yahoo.com