Wiki RT and LT

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I think it really depends upon the payer when it comes to modifiers like 50 or RT & LT. We have some that do not accept any modifiers like Georgia Medicaid. Other than that we use the RT & LT on all exams. Recently we have had denials & requests for the 50. Which we then remove one procedure, add the 50 and double the price. Hope that answers your question.
 
Modifier 25

I need some clarification with this modifier. Here is my senario, My son went to the Dr. because he had impacted cerum in his left ear. The nurses notes talked about the reason for the visit. Then the Doctors not said Rt ear ok. left ear irrigated with warm water, cerum removed. 2 lines written by the doctor about his ear. Then they billed an E and M code 99213-25 there was nothing above and beyond to warrent an office visit also. The reason for the visit was ear blocked. did not do any other Evaluation. Wouldnt the nurses note be included for the visit. it only pertained to his ear nothing else. thanks.:)
 
Not bilateral?

I'm confused by the original post. What exactly do you mean when you say that "a code can't take a modifier 50"?

For example, let's say this is a code for repair of laceration. The integumentary system is not lateral (except for those codes specific to the breasts). So the codes cannot take a -50 modifier, and LT/RT does not apply either.

Do you have a specific example of a code you are confused about?

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
mod 50 vs RT/LT

You need to determine 1st if the procedure can be billed bilaterally.

Typically I would check the Medicare Physician Fee Schedule to see what the ruling there is for bil. If it can be the next step is to check with the specific carrier how they want it.

some want mod 50, one line item, one unit (Medicare)
some want it mod 50, one line item, two units
others want RT/LT one line item, two untis
and I have also found it RT/LT two line items, one unit each.

Impacted Cerumen removal is coded once for one or two ears. If you do only one I recommend using the RT or LT (whichever is appropriate)

AMA Determination:
A major element in determining whether code 69210 should be reported is to understand the definition of impacted cerumen. According to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), impacted cerumen by definition is “if any one or more of the following are present, cerumen should be considered impacted clinically�:
•Visual Considerations – Cerumen impairs exam of clinically significant portions of the external auditory canal, tympanic membrane, or middle ear condition
•Qualitative Considerations – Extremely hard, dry, irritative cerumen causing symptoms such as pain, itching, hearing loss, etc
•Inflammatory Considerations – Associated with foul odor, infection, or dermatitis
•Quantitative Considerations – Obstructive, copious cerumen that cannot be removed without magnification and multiple instruments requiring physician skills

Other issues may also require consideration; however, the removal of ear wax that is NOT impacted does not warrant the reporting of CPT code 69210. This work would be appropriately captured by an E&M code regardless of how it is removed.

I hope this helps.

Cheryl
 
Re: RT and LT modifier

I know this is a little late but here is an article from Medicare that explains the fee schedule. Hope that helps!

MLN Matters 6526


Josie Johnson, COC, CPC, CPMA
 
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