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Modifiers -59 vs -50

L

lindaskin

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18
Location
Iowa City, IA
When billing 21390 for both orbital floor blowout fractures, what modifier is appropriate?
According to Medicare the -50 modifier is not valid.
 
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?
 
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?...
 
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.
 
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?
 
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) :)
 
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.
 
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