Wiki Modifier RT/LT

ellis3350

Guru
Messages
165
Location
Galloway, OH
Best answers
0
Hello,

I'm curious if anyone could explain the Bilateral 50 modifier coding guideline to me. For example CPT 75710,26. I see in Codify the RT/LT are listed as allowable modifiers however I had an audit and was told not to use the laterality modifier due to the reason below. If I'm not mistaken, isn't the reason below meaning not to use both RT and LT on the same line? Any help is appreciated.

0 = 150% payment adjustment for bilateral procedures does not apply. If procedure is reported with modifier -50 or with modifiers RT and LT, base the payment for the two sides on the lower of: (a) the total actual charge for both sides or (b) 100% of the fee schedule amount for a single code.
 
-50 for bilateral is only applicable to certain codes where it has been determined the code description and value is only for one side.
For the example you provided, 75710, -50 is not a valid modifier (even though the description is unilateral) because there is another code 75716 for bilateral.
It would be incorrect to code 75710-50 OR 75710-RT along with 75710-LT. If it was bilateral, you would code only 75716.
If the procedure was ONLY done on one side, there should be no issue with coding 75710-RT OR 75710-LT.

For codes that bilateral does apply, some insurances will want:
#####-50
Others will want
#####-RT
#####-LT

I hope that helps explain it.
 
-50 for bilateral is only applicable to certain codes where it has been determined the code description and value is only for one side.
For the example you provided, 75710, -50 is not a valid modifier (even though the description is unilateral) because there is another code 75716 for bilateral.
It would be incorrect to code 75710-50 OR 75710-RT along with 75710-LT. If it was bilateral, you would code only 75716.
If the procedure was ONLY done on one side, there should be no issue with coding 75710-RT OR 75710-LT.

For codes that bilateral does apply, some insurances will want:
#####-50
Others will want
#####-RT
#####-LT

I hope that helps explain it.
I completely agree. I used 75710,26,RT and 36216,RT and was told I was wrong and got dinged on my audit. Thanks for the explanation.
 
From my experience, this will indeed depend on the payor. Some payors like one code with a -50 and some want two codes with -RT and -LT.
 
Top