RT LT Modifiers and Hernia Surgery

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1
Location
Panama City, FL
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During a recent audit, I was told to remove the RT modifier from the Inguinal Repair. The reviewer stated LT RT is reserved only for paired organs and the inguinal region is not a paired organ. I have searched extensively and I am unable to find any concrete documentation that RT LT modifiers ARE appropriate for Inguinal Repair...can anyone help? Since the CPT code for Inguinal Repair can change based on whether the repair is Initial or Recurrent, I would think that the RT LT modifier would absolutely be necessary especially in cases where the patient has had a previous inguinal hernia but not on the same side as the current surgery.:confused:
 

pkidd

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Local Chapter Officer
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56
Location
Albany, Oregon
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Greetings,

We, too, have been told by a few private payers that we cannot to use RT & LT modifiiers on their claims. ODS (Oregon) is one. Blues (Regence/Oregon) definitely will not accept HCPCS modifiers and I think there was one other private payer.

Yours is the first case that I've heard about an auditor using that phrase (paired organs). I wonder whether that is his/her private opinion!

Our practice has pretty much stopped using RT/LT except on Medicare claims - and, sometimes not even on those. We've been seeing denials when we use RT/LT for AV fistula procedures!

You are absolutely correct - what do you do when you have a bilateral hernia when one is recurrent and the other is initial?

Well - good luck - I think that I just might query that auditor again. :confused:
Pat Kidd
 
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Hello,
when you have a bilateral hernia when one is recurrent and the other is initial
then procedure code wil be different so you can go with RT ,LT modifier.

Thanks,
Balakrishnan CPC-H.
 
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