Modifier - 50

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9
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Omaha AAPC
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We're having some internal discussion here where I work. I currently use the CPT Expert edition which as many of you know gives you the modifier icons that indicate when a code is billable with a modifier - 50.

The internal discussion has come up about the following codes as some examples where a provider is doing the service bilaterally and based on the code description it could be truely done bilaterally. CPT does not show that the code is billable using modifier - 50 nor does the Federal Files that we use as well.

My thought is that the following codes should NOT be billed using Modifier -50 but should instead be billed using multiple units or modifiers for LT and RT.

Here are the code examples that we've been discussing.
21031
11970
42440

Thanks for any input you can give us.
 
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219
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Hi Deanna -
Just confirming your understanding of these codes: - No, they can not be billed with a mod -50. It would be appropriate to use your Level II modifiers (Rt, Lt, ETC...). Depending on the payor - 59 may be used. :)
 

gailmc

Networker
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84
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Amelia, OH
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A great place to check to see if a -50 modifier can be used is Medicare's Physician Fee Schedule Data base. It has a Bilateral indicator: if 1, ok to use 50; if 0, not available for -50 use.
None of the 3 codes listed are eligible for -50 modifer use.
Based on documentation, -59 modifier might be an option.
 

Nikadee

Guest
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Addl Mod 50 Confusion

Our office has been having discussion as to the confusion over the 50 modifier for bilaterial as the actual defination is "bilateral procedures that are performed at the same operative session". To use in operative procedures is clear but what about x-rays done bilateral?? This is a billing service with multiple specialties and we have several different opinions as to the use of modifier 50 when it is for x-rays which of course isn't an operative procedure. Can anybody help clarify the use of modifier 50 for bilateral x-rays??
Thxs,
Nikki Diebolt, CPC
Kent, WA
 
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