lindaskin
Guest
When billing 21390 for both orbital floor blowout fractures, what modifier is appropriate?
According to Medicare the -50 modifier is not valid.
According to Medicare the -50 modifier is not valid.
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Wiki Modifiers -59 vs -50
- Thread starter lindaskin
- Start date
dmaec
True Blue
21390 has a status indicator of "0" in the bilateral column. "0" means - bilateral surgery rules do not apply, do not use modifier 50.
how about RT/LT?
how about RT/LT?
lindaskin
Guest
Is 21390 considered a unilateral or bilateral procedure?
We have tried using the LT & RT without success.
Maybe try billing 2 units? I see Medicare allows 2 and so does UHC, so maybe others do too?
http://www.cms.hhs.gov/apps/ama/lic...loads/Practitioner_DME_Supplier_MUE_Table.zip
https://www.unitedhealthcareonline....Policies/111308_MFD_CPT_Policy_List_09Q1A.htm
http://www.cms.hhs.gov/apps/ama/lic...loads/Practitioner_DME_Supplier_MUE_Table.zip
https://www.unitedhealthcareonline....Policies/111308_MFD_CPT_Policy_List_09Q1A.htm
lindaskin
Guest
Do you know anything about BCBS (IA)?
dmaec
True Blue
what's the exact denial reason they're giving you?
lindaskin
Guest
too many services on the same day
dmaec
True Blue
hmm.. and that's the only code you're billing out?... is there a CCI Edit if you're coding out other codes with it?...
lindaskin
Guest
no other codes billed with it
dmaec
True Blue
well, like bpct6501 said, you might try coding/billing it out with a x2 then, or the .51 or .59 modifier on the second one. (since you already did the RT/LT)
hopefully someone else might have an idea on this...
sorry can't be of more help.
hopefully someone else might have an idea on this...
sorry can't be of more help.lindaskin
Guest
we have tried billing on 2 lines and 1 with a 59 mod
we have also tried billing on 2 lines and 1 w/ a -51,LT mod & the other w/ just the RT
Is this CPT 21390 considered a bilateral already?
we have also tried billing on 2 lines and 1 w/ a -51,LT mod & the other w/ just the RT
Is this CPT 21390 considered a bilateral already?
dmaec
True Blue
well, after a bit more research on the actual procedure itself - it does appear (at least to me) that there isn't a RT/LT or "bilateral" to this procedure - it is simply - the orbital floor (periorbital).
If I were you, I'd ask the surgeon exactly what it was, just to be sure that it isn't a RT/LT/50 procedure.
The description of the 21390 does not say bilateral (I'm thinking because there isn't a bilateral periorbital floor)
If I were you, I'd ask the surgeon exactly what it was, just to be sure that it isn't a RT/LT/50 procedure.
The description of the 21390 does not say bilateral (I'm thinking because there isn't a bilateral periorbital floor)
I've always billed with a 59:
21390-RT
21390-59,LT
Some insurers will deny but pay after I send a written appeal with the OP note.
I recently attended a Medicare webinar on modifiers (I'm in PA) & they suggested using the 76 modifier:
21390-RT
21390-76,LT
I haven't tried this yet so I don't have any experience with payment in this situation.
21390-RT
21390-59,LT
Some insurers will deny but pay after I send a written appeal with the OP note.
I recently attended a Medicare webinar on modifiers (I'm in PA) & they suggested using the 76 modifier:
21390-RT
21390-76,LT
I haven't tried this yet so I don't have any experience with payment in this situation.
dmaec
True Blue
linda, when you find the answer - could you let me know what it is! ! I'd sure appreciate it.
thanks!
I'd sure appreciate it.thanks!