Question RT/LT modifiers for anesthesia??

ALALA

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Aloha, Oregon
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Hello All,

I'm being asked to add the RT or LT modifiers to anesthesia codes for the following insurances: Harvard Pilgrim, UHC, & BCBS of MA.

In my 25 years of billing anesthesia, I've never used these modifier for an anesthesia procedure. Most specifically for 01630, 01400, 01402, 01740
seems for anything shoulder, knee or elbow.

I'm unable to locate any policy or written documentation for this requirement and have asked my billers for direction but am getting no where.

Has anyone else had this issue or request from an insurance ? I'm reluctant to add the mod as it doesn't seem appropriate and would hate to do this and set a precedence for the future.

Any info or advise is appreciated. Especially if you have documentation that supports this either way.
 

enancy79

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Poplar Bluff, MO
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I would agree, this is an unusual request. While I've seen requests for laterality, it has usually been for a pain injection code. What diagnosis is being used? Could they be focused on an unspecified diagnosis when a specific left / right diagnosis code is available.
 

danachock

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Brainerd, MN
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Hi ALALA;​

I have never added a laterality modifier to any of your examples (01630, 01400, 01402, 01740) because the diagnosis(es) codes applied should clearly establish which laterality the surgeon is tending to; but may I ask a question please? Who is asking you to add RT or LT modifiers? If it is your billing team; please be cognizant and ask the important question on why? Are they seeing denials? As a denial specialist they will sometimes ask questions without providing the background. Prime example I see all the time - if the anesthesia charges is being denied for "inappropriate modifier or modifier is missing" it is time to review to make sure you have all the necessary modifiers. For example some insurances NEED/REQUIRE the QK,P3 modifier and actually reviewing the paper copy or electronic version of the claim both may represent that both are not displayed. I could provide several examples of the craziness I've seen working anesthesia denials "back in the day" many years ago and even now. First, identify who is asking you to apply a laterality modifier and why and move forward. If it is not a billing issue, personally I would not add a modifier. I am betting if you added a LT or RT to the anesthesia procedure it would be denied with inappropriate modifier or a required modifier is missing denial. Sometimes insurance carriers can be a little (hmm) how shall I state this - odd and have their own querks. Take the time to google them online. Take their insurance and add a .provider and search (example BCBSMN.provider - would be my search engine). Most of them have medical policies and you should be able to find their anesthesia policy.
I hope you find the answers and if you have more to offer on your coding woes, I may be able to help. But please find the answers.
Thank you for listening and have a great evening,
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT
Anesthesia Coder & Anesthesia Denials
 
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