Renal angio; Bilateral - HELP

cvand1972

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Hello all. When we code 36245 and the procedure is Bilateral, my new coder is using the 50 modifier and changing the units from 1 to 2. Is that really necessary? Doesn't the 50 modifier already say that it's bilateral and all she should really be doing is changing the price to reflect the cost x 2 but not really changing the units?? One of the insurance companies paid triple what they should have. I'm not complaining about the overpayment:), I just want to code correctly.
 

ciphermed

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Reporting 36245 -50 x 1, indicates a bilateral procedure. It seems inappropriate to report 36245 -50 x 2 for a bilateral renal angiogram; hence the "overpayment".

If 36245 -50 x 2 was reported to Medicare on a hospital claim, it would generate a billing edit; OCE 74 Units Greater than one for bilateral procedure billed with modifier -50

Hope this helps,
 

deb9645

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Billing manager

Definition
Bilateral procedure performed at the same session on an anatomical site.
Appropriate Usage:
When the procedure is done bilaterally AND the MPFSDB indicator for the procedure is "1" or "3" report the procedure code once; append with modifier 50 and report with one unit of service.

Appropriate use occurs when the performing services on two bilateral body parts.

Inappropriate Usage:

Reporting this modifier when the performing the service on different areas of the same side of the body.

The BILT SURG indicator is 0,2 or 9.

When removing a lesion on the right arm and one on th left arm.

On a procedure code that is described as a Bilateral in its CPT Description.

Do not report a bilateral procedure on two lines of service and append modifier 50 to second line of service

ADDITIONAL INFORMATION:
WHEN SUBMITTING MODIFIER 50 APPROPRIATELY mEDICARE'S REIMBURSEMENT FOR THE SURGICAL PROCEDURE IS 150 PERCENT OF THE FEE SCHEDULE.

CORRECTLY BILLED FOR BILATERAL PROCEDURE: THE PROCEDURES AND MODIFER 50 WITH UNIT OF 1 WILL PAY AT 150 PERCENT OF THE FEE. THIS IS FOR MEDICARE.
 
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